Provider Demographics
NPI:1366817132
Name:MADLOCK, FRANKIE
Entity Type:Individual
Prefix:
First Name:FRANKIE
Middle Name:
Last Name:MADLOCK
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 1:1105 JUDITH ST
Mailing Address - Street 2:
Mailing Address - City:WESTLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48186-4044
Mailing Address - Country:US
Mailing Address - Phone:313-363-6423
Mailing Address - Fax:
Practice Address - Street 1:1105 JUDITH ST
Practice Address - Street 2:
Practice Address - City:WESTLAND
Practice Address - State:MI
Practice Address - Zip Code:48186-4044
Practice Address - Country:US
Practice Address - Phone:313-363-6423
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-04
Last Update Date:2015-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4703063541164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse