Individual
STACY MADDEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RN, CPNP
Contact information
Practice address
100 N MARIO CAPECCHI DR, SALT LAKE CITY, UT 84113-1103
(801) 662-3600
Mailing address
295 S CHIPETA WAY, SALT LAKE CITY, UT 84108-1287
(801) 587-7400
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
5166712-8900
UT
Other
Enumeration date
02/13/2017
Last updated
02/13/2017
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