Individual
MADELINE K STALEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP-BC
Contact information
Practice address
3452 ANDERSON HWY STE D, POWHATAN MEDICAL ASSOCIATES, POWHATAN, VA 23139-5845
(804) 285-6050
(804) 598-2481
Mailing address
3452 ANDERSON HWY, SUITE D, POWHATAN, VA 23139-5845
(804) 285-6050
(804) 598-2481
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
0024171775
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
C09633
GROUP PTAN
VA
Enumeration date
07/31/2014
Last updated
01/15/2020
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