Provider Demographics
NPI:1376287227
Name:DEWOLFE, MADISON RAE (RN)
Entity Type:Individual
Prefix:
First Name:MADISON
Middle Name:RAE
Last Name:DEWOLFE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:67 MILLBROOK ST STE 406A
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01606-2845
Mailing Address - Country:US
Mailing Address - Phone:508-283-4513
Mailing Address - Fax:508-469-4057
Practice Address - Street 1:67 MILLBROOK ST
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01606-2835
Practice Address - Country:US
Practice Address - Phone:508-283-4513
Practice Address - Fax:508-469-4057
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-26
Last Update Date:2022-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2316982163W00000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse