Provider Demographics
NPI:1477305167
Name:DULIS, MADISON AUDREY
Entity Type:Individual
Prefix:
First Name:MADISON
Middle Name:AUDREY
Last Name:DULIS
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 1:9646 N LENOX PL
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64154-1309
Mailing Address - Country:US
Mailing Address - Phone:480-241-6699
Mailing Address - Fax:
Practice Address - Street 1:1106 REYNOLDS ST STE 100
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:NC
Practice Address - Zip Code:28112-4376
Practice Address - Country:US
Practice Address - Phone:704-289-5443
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-04
Last Update Date:2024-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program