Provider Demographics
NPI:1396596987
Name:SIBBLE, MADALYN RENEE (STNA)
Entity type:Individual
Prefix:
First Name:MADALYN
Middle Name:RENEE
Last Name:SIBBLE
Suffix:
Gender:F
Credentials:STNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:507 OAK MANOR AVE NE
Mailing Address - Street 2:
Mailing Address - City:MASSILLON
Mailing Address - State:OH
Mailing Address - Zip Code:44646-4035
Mailing Address - Country:US
Mailing Address - Phone:330-581-8027
Mailing Address - Fax:
Practice Address - Street 1:507 OAK MANOR AVE NE
Practice Address - Street 2:
Practice Address - City:MASSILLON
Practice Address - State:OH
Practice Address - Zip Code:44646-4035
Practice Address - Country:US
Practice Address - Phone:330-581-8027
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-01
Last Update Date:2024-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH402058200418376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide