Individual
MS. MADISON DALE LAROSE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
APRN, FNP-C
Contact information
Practice address
1515 HOLCOMBE BLVD, HOUSTON, TX 77030-4000
(713) 792-6940
Mailing address
2047 WESTCREEK LN UNIT 409, HOUSTON, TX 77027-3748
(253) 509-3975
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
912181
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1225647985
MEDICARE
TX
05
—
1225647985
—
TX
Enumeration date
07/29/2020
Last updated
12/14/2020
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