Doctor Name: | PAMELA K MADDOX |
NPI Number: | 1073679270 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | MSN-FNP |
License Number: | 47383 |
Business Practice Address: | 4605 Maccorkle Ave Sw South Charleston, WV - 253091311 |
Business Phone Number: | 3043063053 |
Business Fax Number: | 3043063054 |
Mailing Address: | # L-3539, COLUMBUS |
State: | OH |
Postal Code: | 432600001 |
Phone Number: | 3044144800 |
Fax Number: | 3044144801 |
NPI Enumeration Date: | 12/29/2006 |
NPI Last Update Date: | 04/08/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LW0102X |
License Number: | 47383 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | WV |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Women's Health |
Taxonomy Definition: |