Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2200X | Nurse Practitioner - Adult Health | SP021525 | PA |
NPI | 1023421344 |
---|---|
Provider Name | Ms. Jody Lynn Madden |
First Address | Monroeville, PA 15146-2184 |
Second Address | Monroeville, PA 15146-2807 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/06/2014 |
Last Update Date | 16/11/2021 |