Provider Demographics
NPI:1043974595
Name:FORTENER, MADELEINE ANN (CNP)
Entity Type:Individual
Prefix:
First Name:MADELEINE
Middle Name:ANN
Last Name:FORTENER
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5327 NEWTONSVILLE HUTCHINSON RD
Mailing Address - Street 2:
Mailing Address - City:BATAVIA
Mailing Address - State:OH
Mailing Address - Zip Code:45103-9511
Mailing Address - Country:US
Mailing Address - Phone:513-981-4170
Mailing Address - Fax:513-981-4171
Practice Address - Street 1:5327 NEWTONSVILLE HUTCHINSON RD
Practice Address - Street 2:
Practice Address - City:BATAVIA
Practice Address - State:OH
Practice Address - Zip Code:45103-9511
Practice Address - Country:US
Practice Address - Phone:513-981-4170
Practice Address - Fax:513-981-4171
Is Sole Proprietor?:No
Enumeration Date:2021-10-29
Last Update Date:2021-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.0029060363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily