Individual
MADERICA BACON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
2401 S 31ST ST, TEMPLE, TX 76508-1820
(254) 724-2111
Mailing address
PO BOX 844658, DALLAS, TX 75284-4658
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
1022177
TX
367500000X
Certified Registered Nurse Anesthetist
Primary
0024195841
VA
367500000X
Certified Registered Nurse Anesthetist
1022177
TX
Other
Enumeration date
08/31/2012
Last updated
01/19/2026
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