Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2200X | Nurse Practitioner - Adult Health | 2014003648 | MO |
N | 363LW0102X | Nurse Practitioner - Women's Health | 2012010642 | MO |
NPI | 1053665448 |
---|---|
Provider Name | Mrs. Natoya Renee Madge |
First Address | Kansas City, MO 64108-2727 |
Second Address | Kansas City, MO 64108-2727 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/11/2012 |
Last Update Date | 16/02/2017 |