Individual
ANGELIQUE MADISON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
400 MEDICAL PARK DR, WATERVLIET, MI 49098-9225
(269) 463-3600
Mailing address
6701 PAW PAW AVE, COLOMA, MI 49038-9519
(269) 463-3000
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
4704253993
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1417358995
—
MI
Enumeration date
09/15/2014
Last updated
11/13/2015
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