Provider Demographics
NPI:1922680065
Name:SWEENEY, MADISON ROSE (FNP-BC)
Entity Type:Individual
Prefix:
First Name:MADISON
Middle Name:ROSE
Last Name:SWEENEY
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2606 PEDDLERS VILLAGE RD
Mailing Address - Street 2:
Mailing Address - City:GOSHEN
Mailing Address - State:IN
Mailing Address - Zip Code:46526-1004
Mailing Address - Country:US
Mailing Address - Phone:574-534-3300
Mailing Address - Fax:574-534-5412
Practice Address - Street 1:2606 PEDDLERS VILLAGE RD
Practice Address - Street 2:
Practice Address - City:GOSHEN
Practice Address - State:IN
Practice Address - Zip Code:46526-1004
Practice Address - Country:US
Practice Address - Phone:574-534-3300
Practice Address - Fax:574-534-5412
Is Sole Proprietor?:No
Enumeration Date:2021-04-27
Last Update Date:2024-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71011485A363LF0000X
IN3430483028172A00000X
MI4704351149163W00000X
IN28215836A163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No172A00000XOther Service ProvidersDriver
No163W00000XNursing Service ProvidersRegistered Nurse