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Individual

MRS. JENNIFER ANN MADLEM

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
FNP, MSN, RN

Contact information

Practice address
209 FLORENCE AVE, GRANGER, IN 46530-8048
(574) 246-1000
(574) 246-4000
Mailing address
63501 BEECH RD, WAKARUSA, IN 46573-9643
(574) 633-4241

Taxonomy

Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
71001526A
IN
363LF0000X
Family Nurse Practitioner
Primary
71001526A
IN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
200425160
IN
Enumeration date
11/17/2006
Last updated
04/08/2015
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