Individual
MADISON TACKER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
3000 GOFFS FALLS RD STE 101, MANCHESTER, NH 03103-6109
(800) 995-2673
(800) 995-2673
Mailing address
3000 GOFFS FALLS RD STE 101, MANCHESTER, NH 03103-6109
(800) 995-2673
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
025.0133125
VT
164W00000X
Licensed Practical Nurse
Primary
L058032
AR
Other
Enumeration date
11/27/2017
Last updated
11/27/2017
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