Provider Demographics
NPI:1033162292
Name:MADISON, ELIZABETH E (CRNP)
Entity Type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:E
Last Name:MADISON
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2420 W PIERCE ST STE 100
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:NM
Mailing Address - Zip Code:88220-3517
Mailing Address - Country:US
Mailing Address - Phone:575-234-1855
Mailing Address - Fax:575-628-0493
Practice Address - Street 1:2420 W PIERCE ST
Practice Address - Street 2:STE 100
Practice Address - City:CARLSBAD
Practice Address - State:NM
Practice Address - Zip Code:88220-3543
Practice Address - Country:US
Practice Address - Phone:575-234-1855
Practice Address - Fax:575-234-2854
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2020-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMR20333363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMP00319597OtherRAILROAD MEDICARE
NM00NM006E09OtherBCBS
NM40322581Medicaid
NMP00319597OtherRAILROAD MEDICARE