Provider Demographics
NPI:1003674193
Name:WISDOM, MADISON (FNP-BC)
Entity Type:Individual
Prefix:
First Name:MADISON
Middle Name:
Last Name:WISDOM
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:MADISON
Other - Middle Name:
Other - Last Name:SHIRVEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6339 CHARLOTTE PIKE # 1268
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37209-2926
Mailing Address - Country:US
Mailing Address - Phone:629-249-6815
Mailing Address - Fax:
Practice Address - Street 1:6339 CHARLOTTE PIKE # 1268
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37209-2926
Practice Address - Country:US
Practice Address - Phone:615-598-2027
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-12
Last Update Date:2024-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN33943363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily