Individual
MARY MARGARET MADRAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN,BC
Contact information
Practice address
6505 N ILLINOIS ST, FAIRVIEW HEIGHTS, IL 62208-2001
(314) 687-2734
Mailing address
PO BOX 955534, SAINT LOUIS, MO 63195-5534
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
140767
MO
363L00000X
Nurse Practitioner
Primary
277000522
IL
363LF0000X
Family Nurse Practitioner
140767
MO
Other
Enumeration date
07/03/2006
Last updated
10/23/2020
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