Provider Demographics
NPI:1578199865
Name:BOSWELL, MADISON WHITLOCK (CPNP-PC)
Entity Type:Individual
Prefix:
First Name:MADISON
Middle Name:WHITLOCK
Last Name:BOSWELL
Suffix:
Gender:F
Credentials:CPNP-PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:404 WESTWOOD AVE STE 103
Mailing Address - Street 2:
Mailing Address - City:HIGH POINT
Mailing Address - State:NC
Mailing Address - Zip Code:27262-4316
Mailing Address - Country:US
Mailing Address - Phone:336-409-6504
Mailing Address - Fax:
Practice Address - Street 1:2001 TODAYS WOMAN AVE
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27105-5069
Practice Address - Country:US
Practice Address - Phone:336-722-1818
Practice Address - Fax:336-722-1826
Is Sole Proprietor?:No
Enumeration Date:2020-03-18
Last Update Date:2023-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5012980208000000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No208000000XAllopathic & Osteopathic PhysiciansPediatrics