Provider Demographics
NPI:1598508210
Name:OBMANN, MADISON FAITH
Entity type:Individual
Prefix:MRS
First Name:MADISON
Middle Name:FAITH
Last Name:OBMANN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MADISON
Other - Middle Name:FAITH
Other - Last Name:LINGLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3939 PERKINS AVE
Mailing Address - Street 2:
Mailing Address - City:WALL LAKE
Mailing Address - State:IA
Mailing Address - Zip Code:51466-7579
Mailing Address - Country:US
Mailing Address - Phone:712-571-0735
Mailing Address - Fax:
Practice Address - Street 1:311 S CLARK ST
Practice Address - Street 2:
Practice Address - City:CARROLL
Practice Address - State:IA
Practice Address - Zip Code:51401-3038
Practice Address - Country:US
Practice Address - Phone:712-794-5204
Practice Address - Fax:712-794-5205
Is Sole Proprietor?:No
Enumeration Date:2024-06-18
Last Update Date:2024-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA169133163WE0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WE0003XNursing Service ProvidersRegistered NurseEmergency