1326547944 NPI number — SYDNEY LEE MADDEN MSN, APRN, FNP-BC

Table of content: SYDNEY LEE MADDEN MSN, APRN, FNP-BC (NPI 1326547944)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326547944 NPI number — SYDNEY LEE MADDEN MSN, APRN, FNP-BC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MADDEN
Provider First Name:
SYDNEY
Provider Middle Name:
LEE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MSN, APRN, FNP-BC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
GEORGE
Provider Other First Name:
SYDNEY
Provider Other Middle Name:
LEE
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1326547944
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/24/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9716 MERLOT LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NORTH LITTLE ROCK
Provider Business Mailing Address State Name:
AR
Provider Business Mailing Address Postal Code:
72118-1160
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
254-630-3020
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3010 FOUNTAIN DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CONWAY
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
72034
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
501-328-0055
Provider Business Practice Location Address Fax Number:
501-328-2194
Provider Enumeration Date:
02/09/2018

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:  A005456 , registered in the state of AR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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