Provider Demographics
NPI:1124466958
Name:MADERE, CHAD M (NP)
Entity type:Individual
Prefix:
First Name:CHAD
Middle Name:M
Last Name:MADERE
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:827 N PINE ST
Mailing Address - Street 2:
Mailing Address - City:GRAMERCY
Mailing Address - State:LA
Mailing Address - Zip Code:70052-3659
Mailing Address - Country:US
Mailing Address - Phone:225-869-9200
Mailing Address - Fax:225-869-9241
Practice Address - Street 1:827 N PINE ST
Practice Address - Street 2:
Practice Address - City:GRAMERCY
Practice Address - State:LA
Practice Address - Zip Code:70052-3659
Practice Address - Country:US
Practice Address - Phone:225-869-9200
Practice Address - Fax:225-869-9241
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-14
Last Update Date:2014-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LATAP003099363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2349686Medicaid
LA313649YUZPMedicare PIN