Individual
MADELON CAROL PERKINS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
FNP-C
Contact information
Practice address
12707 W CARAVEO PL, PEORIA, AZ 85383-8067
(623) 810-9659
Mailing address
12707 W CARAVEO PL, PEORIA, AZ 85383-8067
(623) 810-9659
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
250714
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
D01467208
DRIVER LICENSE
AZ
Enumeration date
12/09/2020
Last updated
12/09/2020
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