Provider Demographics
NPI:1811582380
Name:MADDOX, NANCY CHEYENNE (LPN)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:CHEYENNE
Last Name:MADDOX
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3100 CRISP SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:MCMINNVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37110-5238
Mailing Address - Country:US
Mailing Address - Phone:931-939-5045
Mailing Address - Fax:
Practice Address - Street 1:3100 CRISP SPRINGS RD
Practice Address - Street 2:
Practice Address - City:MCMINNVILLE
Practice Address - State:TN
Practice Address - Zip Code:37110-5238
Practice Address - Country:US
Practice Address - Phone:931-939-5045
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-05
Last Update Date:2021-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN93795164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN116111934OtherDRIVER LICENSE