Doctor Name: | MRS. CHRISTINE MARIE MADDOX |
NPI Number: | 1063483642 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | F.N.P. |
License Number: | 71001740A |
Business Practice Address: | 304 Detroit St La Porte, IN - 463502497 |
Business Phone Number: | 2193253770 |
Business Fax Number: | 2193258181 |
Mailing Address: | Po Box 1690, LA PORTE |
State: | IN |
Postal Code: | 463521690 |
Phone Number: | 2193262312 |
Fax Number: | 2193262584 |
NPI Enumeration Date: | 01/31/2006 |
NPI Last Update Date: | 10/05/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | 71001740A |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IN |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |