1609900836 NPI number — MADONNA L FERRIS APRN-BC-FNP

Table of content: MADONNA L FERRIS APRN-BC-FNP (NPI 1609900836)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609900836 NPI number — MADONNA L FERRIS APRN-BC-FNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FERRIS
Provider First Name:
MADONNA
Provider Middle Name:
L
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
APRN-BC-FNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1609900836
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/24/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3711 N EVERBROOK LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MUNCIE
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
47304-5270
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
765-287-8593
Provider Business Mailing Address Fax Number:
765-287-8593

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
601 BUSINESS LOOP 70 W
Provider Second Line Business Practice Location Address:
STE 275
Provider Business Practice Location Address City Name:
COLUMBIA
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
65203-2585
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
573-874-0008
Provider Business Practice Location Address Fax Number:
573-875-5350
Provider Enumeration Date:
03/16/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  71009895A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 363LF0000X , with the licence number: 129711 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)





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