Provider Demographics
NPI:1851134449
Name:WALDROOP, MADISON R
Entity type:Individual
Prefix:
First Name:MADISON R
Middle Name:
Last Name:WALDROOP
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42640 HARRIS RD
Mailing Address - Street 2:
Mailing Address - City:BELLEVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48111-9508
Mailing Address - Country:US
Mailing Address - Phone:734-308-9493
Mailing Address - Fax:
Practice Address - Street 1:42640 HARRIS RD
Practice Address - Street 2:
Practice Address - City:BELLEVILLE
Practice Address - State:MI
Practice Address - Zip Code:48111-9508
Practice Address - Country:US
Practice Address - Phone:734-308-9493
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-13
Last Update Date:2024-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker