Provider Demographics
NPI:1164067781
Name:MADALINSKI, WALTER JOSEPH III (AGCNS)
Entity Type:Individual
Prefix:
First Name:WALTER
Middle Name:JOSEPH
Last Name:MADALINSKI
Suffix:III
Gender:M
Credentials:AGCNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700A W WHITESTONE BLVD # A
Mailing Address - Street 2:
Mailing Address - City:CEDAR PARK
Mailing Address - State:TX
Mailing Address - Zip Code:78613-2119
Mailing Address - Country:US
Mailing Address - Phone:512-331-5828
Mailing Address - Fax:
Practice Address - Street 1:700A W WHITESTONE BLVD # A
Practice Address - Street 2:
Practice Address - City:CEDAR PARK
Practice Address - State:TX
Practice Address - Zip Code:78613-2119
Practice Address - Country:US
Practice Address - Phone:512-331-5828
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-07
Last Update Date:2019-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP138658364SA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SA2200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAdult Health