Provider Demographics
NPI:1699135046
Name:MADRUGA, DANIELLE (RN, CRT)
Entity type:Individual
Prefix:
First Name:DANIELLE
Middle Name:
Last Name:MADRUGA
Suffix:
Gender:F
Credentials:RN, CRT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 APPLE RD APT 31
Mailing Address - Street 2:
Mailing Address - City:BEVERLY
Mailing Address - State:MA
Mailing Address - Zip Code:01915-5389
Mailing Address - Country:US
Mailing Address - Phone:781-316-4150
Mailing Address - Fax:
Practice Address - Street 1:35 APPLE RD APT 31
Practice Address - Street 2:
Practice Address - City:BEVERLY
Practice Address - State:MA
Practice Address - Zip Code:01915-5389
Practice Address - Country:US
Practice Address - Phone:781-316-4150
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-27
Last Update Date:2016-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2296091163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse