Provider Demographics
NPI:1275953598
Name:MADDOX, ANNA (REGISTERED NURSE)
Entity Type:Individual
Prefix:MS
First Name:ANNA
Middle Name:
Last Name:MADDOX
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6124 HICKORY TRL
Mailing Address - Street 2:
Mailing Address - City:WHITE LAKE
Mailing Address - State:MI
Mailing Address - Zip Code:48383-3501
Mailing Address - Country:US
Mailing Address - Phone:734-552-1148
Mailing Address - Fax:
Practice Address - Street 1:6124 HICKORY TRL
Practice Address - Street 2:
Practice Address - City:WHITE LAKE
Practice Address - State:MI
Practice Address - Zip Code:48383-3501
Practice Address - Country:US
Practice Address - Phone:734-552-1148
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-25
Last Update Date:2014-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704304922163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse