Provider Demographics
NPI:1417652967
Name:ROSSI, MADELIN (PA)
Entity Type:Individual
Prefix:
First Name:MADELIN
Middle Name:
Last Name:ROSSI
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:MADI
Other - Middle Name:
Other - Last Name:ROSSI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA
Mailing Address - Street 1:6606 36TH ST
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79407-1812
Mailing Address - Country:US
Mailing Address - Phone:806-869-6121
Mailing Address - Fax:
Practice Address - Street 1:6606 36TH ST
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79407-1812
Practice Address - Country:US
Practice Address - Phone:806-869-6121
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-04
Last Update Date:2023-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA17217363A00000X
TX20232255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer