Provider Demographics
NPI:1114396934
Name:MADRIGAL, E (REGISTER NURSE)
Entity Type:Individual
Prefix:
First Name:E
Middle Name:
Last Name:MADRIGAL
Suffix:
Gender:F
Credentials:REGISTER NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1811 GRAYWOOD CT
Mailing Address - Street 2:
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78045-8318
Mailing Address - Country:US
Mailing Address - Phone:956-290-6062
Mailing Address - Fax:956-568-8371
Practice Address - Street 1:1811 GRAYWOOD CT
Practice Address - Street 2:
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78045-8318
Practice Address - Country:US
Practice Address - Phone:956-290-6062
Practice Address - Fax:956-568-8371
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-22
Last Update Date:2015-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX739257171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator