Provider Demographics
NPI:1114244092
Name:MADISON, BARBARA ANN
Entity Type:Individual
Prefix:MS
First Name:BARBARA
Middle Name:ANN
Last Name:MADISON
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:BARBARA
Other - Middle Name:ANN
Other - Last Name:MADISON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN
Mailing Address - Street 1:PO BOX 65
Mailing Address - Street 2:
Mailing Address - City:TWINSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:44087-0065
Mailing Address - Country:US
Mailing Address - Phone:216-799-5839
Mailing Address - Fax:
Practice Address - Street 1:17916 NORTH BLVD
Practice Address - Street 2:
Practice Address - City:MAPLE HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44137-2749
Practice Address - Country:US
Practice Address - Phone:216-799-5839
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-30
Last Update Date:2010-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN137687163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2320581Medicaid