Provider Demographics
NPI:1417692336
Name:NOE, MADDIE SHEA
Entity Type:Individual
Prefix:
First Name:MADDIE
Middle Name:SHEA
Last Name:NOE
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:PO BOX 522
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:AL
Mailing Address - Zip Code:35570-0522
Mailing Address - Country:US
Mailing Address - Phone:205-921-2838
Mailing Address - Fax:
Practice Address - Street 1:400 BEXAR AVE W
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:AL
Practice Address - Zip Code:35570-5522
Practice Address - Country:US
Practice Address - Phone:205-921-2838
Practice Address - Fax:205-430-2672
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-04
Last Update Date:2022-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-150600363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily