Provider Demographics
NPI:1770821910
Name:MADISON, JESSICA (RNP)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:MADISON
Suffix:
Gender:F
Credentials:RNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:PAWTUCKET
Mailing Address - State:RI
Mailing Address - Zip Code:02861-1333
Mailing Address - Country:US
Mailing Address - Phone:401-404-2975
Mailing Address - Fax:401-404-2976
Practice Address - Street 1:25 THURBER BLVD
Practice Address - Street 2:UNIT 6
Practice Address - City:SMITHFIELD
Practice Address - State:RI
Practice Address - Zip Code:02917-1816
Practice Address - Country:US
Practice Address - Phone:401-404-2975
Practice Address - Fax:401-404-2976
Is Sole Proprietor?:No
Enumeration Date:2013-01-23
Last Update Date:2013-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RINPP37700363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner