Provider Demographics
NPI:1942323001
Name:MADSEN, SALLY C (RN)
Entity Type:Individual
Prefix:
First Name:SALLY
Middle Name:C
Last Name:MADSEN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 852
Mailing Address - Street 2:
Mailing Address - City:CALAIS
Mailing Address - State:ME
Mailing Address - Zip Code:04619-0852
Mailing Address - Country:US
Mailing Address - Phone:207-214-4572
Mailing Address - Fax:207-451-8473
Practice Address - Street 1:10 BARKER ST
Practice Address - Street 2:
Practice Address - City:CALAIS
Practice Address - State:ME
Practice Address - Zip Code:04619-1404
Practice Address - Country:US
Practice Address - Phone:207-454-2743
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-06
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MER033529163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health