Provider Demographics
NPI:1376523241
Name:MADDEN, CAROL ANNE (CFNP)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:ANNE
Last Name:MADDEN
Suffix:
Gender:F
Credentials:CFNP
Other - Prefix:
Other - First Name:CAROL
Other - Middle Name:ANNE
Other - Last Name:KELLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:12425 APACHE PL NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87112-3605
Mailing Address - Country:US
Mailing Address - Phone:505-296-0689
Mailing Address - Fax:
Practice Address - Street 1:801 ENCINO PL NE
Practice Address - Street 2:STE A-6
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87102-2612
Practice Address - Country:US
Practice Address - Phone:505-224-7400
Practice Address - Fax:505-224-7404
Is Sole Proprietor?:No
Enumeration Date:2006-01-18
Last Update Date:2010-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMR07953207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
S47604Medicare UPIN