Provider Demographics
NPI:1316673932
Name:STARR, MADELEINE ROSE
Entity type:Individual
Prefix:
First Name:MADELEINE
Middle Name:ROSE
Last Name:STARR
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4835 E CACTUS RD STE 130
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85254-3545
Mailing Address - Country:US
Mailing Address - Phone:480-581-4877
Mailing Address - Fax:
Practice Address - Street 1:4835 E CACTUS RD STE 130
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85254-3545
Practice Address - Country:US
Practice Address - Phone:480-581-4877
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-26
Last Update Date:2025-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ307648363LF0000X
IL209.025467363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily