Individual
JILL IRENE MADDACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APN
Contact information
Practice address
4500 W 181ST AVE, LOWELL, IN 46356-0017
(219) 690-2016
(219) 690-1862
Mailing address
PO BOX 781076, DETROIT, MI 48278-1076
(317) 528-4800
(317) 865-1479
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
28107133A
IN
363LF0000X
Family Nurse Practitioner
Primary
71004266A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201173110
—
IN
Enumeration date
10/18/2012
Last updated
10/11/2023
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