Individual
MR. SCOTT MICHAEL MADDOCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
BSN, RN, CRNFA, CNOR
Contact information
Practice address
1040 WINTER LAKE DR, FENTON, MO 63026-8016
(314) 477-6927
Mailing address
1040 WINTER LAKE DR, FENTON, MO 63026-8016
(314) 477-6927
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
155911
MO
Other
Enumeration date
10/29/2018
Last updated
10/29/2018
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