Individual
LUE R MADISON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
15207 SW 114TH PL, ARCHER, FL 32618-3923
(352) 275-3070
(352) 495-3131
Mailing address
15207 SW 114TH PL, ARCHER, FL 32618-3923
Taxonomy
Speciality
Code
Description
License number
State
376K00000X
Nurse's Aide
Primary
141949
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
D9916297
SECURITY OFFICER
FL
Enumeration date
01/22/2018
Last updated
01/22/2018
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