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Individual

MADISON LEE JAMES

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F

Contact information

Practice address
692 W 2075 N, CENTERVILLE, UT 84014-2611
(801) 638-7595
Mailing address
692 W 2075 N, CENTERVILLE, UT 84014-2611
(801) 638-7595

Taxonomy

Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
12839605-3101
UT

Other

Enumeration date
08/24/2022
Last updated
08/24/2022
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