Provider Demographics
NPI:1366824401
Name:MADDEN, JESSICA (CNP)
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:
Last Name:MADDEN
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2160 OLD HICKORY LN
Mailing Address - Street 2:
Mailing Address - City:HOLLAND
Mailing Address - State:OH
Mailing Address - Zip Code:43528-9570
Mailing Address - Country:US
Mailing Address - Phone:419-270-1972
Mailing Address - Fax:
Practice Address - Street 1:2841 MUNDING DR
Practice Address - Street 2:
Practice Address - City:OREGON
Practice Address - State:OH
Practice Address - Zip Code:43616-3290
Practice Address - Country:US
Practice Address - Phone:419-697-4100
Practice Address - Fax:216-749-0141
Is Sole Proprietor?:No
Enumeration Date:2015-06-25
Last Update Date:2023-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.17634363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0144354Medicaid