Individual
MADDALENA DAVENPORT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN
Contact information
Practice address
401 N MAIN ST, ROANOKE, IL 61561-7585
(309) 923-2661
Mailing address
918 E CLEVELAND ST, LADD, IL 61329-9720
(815) 303-7652
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
209030516
IL
Other
Enumeration date
09/10/2024
Last updated
09/13/2024
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