Individual
PENNY J MADER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CNP
Contact information
Practice address
1055 N 500 W, ATTN CREDENTIALING, PROVO, UT 84604
(801) 354-8225
(801) 418-0941
Mailing address
1055 N 500 W, ATTN CREDENTIALING, PROVO, UT 84604-4232
(801) 354-8225
(801) 418-0941
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
13327156-4405
UT
363L00000X
Nurse Practitioner
CNP-01828
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
48922218
—
NM
Enumeration date
08/19/2011
Last updated
05/24/2023
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