Provider Demographics
NPI:1043522030
Name:MADDOX, VELLA (RN)
Entity Type:Individual
Prefix:
First Name:VELLA
Middle Name:
Last Name:MADDOX
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2836 COUNTY ROAD 16060
Mailing Address - Street 2:
Mailing Address - City:DEPORT
Mailing Address - State:TX
Mailing Address - Zip Code:75435-4800
Mailing Address - Country:US
Mailing Address - Phone:903-632-5828
Mailing Address - Fax:903-632-5828
Practice Address - Street 1:2836 COUNTY ROAD 16060
Practice Address - Street 2:
Practice Address - City:DEPORT
Practice Address - State:TX
Practice Address - Zip Code:75435-4800
Practice Address - Country:US
Practice Address - Phone:903-632-5828
Practice Address - Fax:903-632-5828
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-08
Last Update Date:2010-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX640902163WG0000X, 372500000X, 372600000X, 374700000X, 3747A0650X, 3747P1801X, 374U00000X, 376J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice
No372500000XNursing Service Related ProvidersChore Provider
No372600000XNursing Service Related ProvidersAdult Companion
No374700000XNursing Service Related ProvidersTechnician
No3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No374U00000XNursing Service Related ProvidersHome Health Aide
No376J00000XNursing Service Related ProvidersHomemaker