Provider Demographics
NPI:1073858304
Name:MADARA, MEGAN (ANP-BC)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:
Last Name:MADARA
Suffix:
Gender:F
Credentials:ANP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 BRADWAHL DR
Mailing Address - Street 2:
Mailing Address - City:MORRISTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07960-6131
Mailing Address - Country:US
Mailing Address - Phone:201-407-8033
Mailing Address - Fax:908-925-7910
Practice Address - Street 1:850 N WOOD AVE
Practice Address - Street 2:
Practice Address - City:LINDEN
Practice Address - State:NJ
Practice Address - Zip Code:07036-4038
Practice Address - Country:US
Practice Address - Phone:908-925-9309
Practice Address - Fax:908-925-7910
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-27
Last Update Date:2013-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00405300363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health