Provider Demographics
NPI:1225230386
Name:TRUMM, MADONNA
Entity Type:Individual
Prefix:
First Name:MADONNA
Middle Name:
Last Name:TRUMM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:N4966 BEACH GARDEN RD
Mailing Address - Street 2:
Mailing Address - City:POYNETTE
Mailing Address - State:WI
Mailing Address - Zip Code:53955-8840
Mailing Address - Country:US
Mailing Address - Phone:608-242-8335
Mailing Address - Fax:608-240-7060
Practice Address - Street 1:1414 MAC ARTHUR RD
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53714-1318
Practice Address - Country:US
Practice Address - Phone:608-242-8335
Practice Address - Fax:608-240-7060
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1204-033363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner