Individual
MADDISON COREEN WHITMORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1032 E SUMNER ST, HARTFORD, WI 53027-1608
(262) 673-2300
Mailing address
PO BOX 735044, CHICAGO, IL 60673-5044
(800) 326-2250
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
14519
MN
363A00000X
Physician Assistant
Primary
8049
WI
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100297720
—
WI
Enumeration date
02/09/2022
Last updated
04/11/2025
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