Provider Demographics
NPI:1427214162
Name:MADEKER, TIMBERLEE B (CPNP)
Entity Type:Individual
Prefix:
First Name:TIMBERLEE
Middle Name:B
Last Name:MADEKER
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:TIMBERLEE
Other - Middle Name:B
Other - Last Name:SHARROCK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CPNP
Mailing Address - Street 1:10 WOODLAKE TRL STE C
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:OH
Mailing Address - Zip Code:43050-9573
Mailing Address - Country:US
Mailing Address - Phone:740-392-7337
Mailing Address - Fax:740-392-7333
Practice Address - Street 1:10 WOODLAKE TRL STE C
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:OH
Practice Address - Zip Code:43050-9573
Practice Address - Country:US
Practice Address - Phone:740-392-7337
Practice Address - Fax:740-392-7333
Is Sole Proprietor?:No
Enumeration Date:2008-08-01
Last Update Date:2022-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.10127363LP0200X, 363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2943382Medicaid