Provider Demographics
NPI:1043679905
Name:JOHNSON MADRY, EEATA ELIZABETH (MSN, RN, FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:EEATA
Middle Name:ELIZABETH
Last Name:JOHNSON MADRY
Suffix:
Gender:F
Credentials:MSN, RN, FNP-C
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Mailing Address - Street 1:PO BOX 2705
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35804-2705
Mailing Address - Country:US
Mailing Address - Phone:256-265-4600
Mailing Address - Fax:256-265-4651
Practice Address - Street 1:201 SIVLEY RD SW STE 620
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35801-5102
Practice Address - Country:US
Practice Address - Phone:562-654-6002
Practice Address - Fax:256-265-4651
Is Sole Proprietor?:No
Enumeration Date:2016-02-19
Last Update Date:2019-03-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AL1-126992363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily