Provider Demographics
NPI:1801222690
Name:MADKINS, DELIA SHAVON (LVN)
Entity Type:Individual
Prefix:
First Name:DELIA
Middle Name:SHAVON
Last Name:MADKINS
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1937 HILLTOP DR
Mailing Address - Street 2:
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76710-1035
Mailing Address - Country:US
Mailing Address - Phone:254-339-9581
Mailing Address - Fax:
Practice Address - Street 1:1937 HILLTOP DR
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76710-1035
Practice Address - Country:US
Practice Address - Phone:254-339-9581
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-24
Last Update Date:2013-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX231225164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse