Provider Demographics
NPI:1528281870
Name:MADDEN, KELLY (LPN)
Entity type:Individual
Prefix:MS
First Name:KELLY
Middle Name:
Last Name:MADDEN
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:65 SAWYER AVE
Mailing Address - Street 2:
Mailing Address - City:ATKINSON
Mailing Address - State:NH
Mailing Address - Zip Code:03811-2446
Mailing Address - Country:US
Mailing Address - Phone:603-362-9649
Mailing Address - Fax:
Practice Address - Street 1:65 SAWYER AVE
Practice Address - Street 2:
Practice Address - City:ATKINSON
Practice Address - State:NH
Practice Address - Zip Code:03811-2446
Practice Address - Country:US
Practice Address - Phone:603-362-9649
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA57183164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse