Provider Demographics
NPI:1194959213
Name:MADDEN, JACQUELINE ANGELA (MS, RN, PNP)
Entity type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:ANGELA
Last Name:MADDEN
Suffix:
Gender:F
Credentials:MS, RN, PNP
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Other - Middle Name:
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Mailing Address - Street 1:747 52ND ST
Mailing Address - Street 2:DEPARTMENT OF GASTROENTEROLOGY
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94609-1809
Mailing Address - Country:US
Mailing Address - Phone:510-428-3885
Mailing Address - Fax:510-597-7168
Practice Address - Street 1:747 52ND ST
Practice Address - Street 2:DEPARTMENT OF GASTROENTEROLOGY
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94609-1809
Practice Address - Country:US
Practice Address - Phone:510-428-3885
Practice Address - Fax:510-597-7168
Is Sole Proprietor?:No
Enumeration Date:2009-05-04
Last Update Date:2009-05-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA585932163W00000X
CA12864 - CERTIFICATE363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No163W00000XNursing Service ProvidersRegistered Nurse