Provider Demographics
NPI:1720364797
Name:MADONDO, JOHN (NP)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:
Last Name:MADONDO
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1307 BELL RD
Mailing Address - Street 2:SUITE 111
Mailing Address - City:ANTIOCH
Mailing Address - State:TN
Mailing Address - Zip Code:37013-3745
Mailing Address - Country:US
Mailing Address - Phone:615-953-3633
Mailing Address - Fax:615-953-3634
Practice Address - Street 1:1307 BELL RD
Practice Address - Street 2:SUITE 111
Practice Address - City:ANTIOCH
Practice Address - State:TN
Practice Address - Zip Code:37013-3745
Practice Address - Country:US
Practice Address - Phone:615-953-3633
Practice Address - Fax:615-953-3634
Is Sole Proprietor?:No
Enumeration Date:2011-10-22
Last Update Date:2011-10-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TN7187363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily