Provider Demographics
NPI:1578103636
Name:EUDY, MADELYN LAINE (PA-C)
Entity Type:Individual
Prefix:
First Name:MADELYN
Middle Name:LAINE
Last Name:EUDY
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Gender:F
Credentials:PA-C
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Mailing Address - Street 1:11301 GOLF LINKS DR N STE 203
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28277-8014
Mailing Address - Country:US
Mailing Address - Phone:704-321-3376
Mailing Address - Fax:
Practice Address - Street 1:349 VENUS ST
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:NC
Practice Address - Zip Code:28112-4025
Practice Address - Country:US
Practice Address - Phone:980-380-9901
Practice Address - Fax:704-541-6558
Is Sole Proprietor?:No
Enumeration Date:2020-01-07
Last Update Date:2024-04-09
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Provider Licenses
StateLicense IDTaxonomies
NC001009701363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant