Provider Demographics
NPI:1962134825
Name:MADISON, MADELINE M (APRN, FNP-BC)
Entity type:Individual
Prefix:
First Name:MADELINE
Middle Name:M
Last Name:MADISON
Suffix:
Gender:F
Credentials:APRN, FNP-BC
Other - Prefix:
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Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:24 FRANK LLOYD WRIGHT DRIVE
Mailing Address - Street 2:SUITE J2000
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48105
Mailing Address - Country:US
Mailing Address - Phone:734-747-6766
Mailing Address - Fax:734-222-3100
Practice Address - Street 1:THIMG PRIMARY CARE-CANTON
Practice Address - Street 2:1600 S. CANTON CENTER RD SUITE 200
Practice Address - City:CANTON
Practice Address - State:MI
Practice Address - Zip Code:48188
Practice Address - Country:US
Practice Address - Phone:734-398-7880
Practice Address - Fax:734-761-7318
Is Sole Proprietor?:No
Enumeration Date:2022-06-29
Last Update Date:2024-06-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4704342548163W00000X, 363LF0000X
MI2023126823363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse