Provider Demographics
NPI:1962501031
Name:NYE, MADELENE LENANN (EDD)
Entity Type:Individual
Prefix:DR
First Name:MADELENE
Middle Name:LENANN
Last Name:NYE
Suffix:
Gender:F
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1510 WEST FAIRMONT
Mailing Address - Street 2:SUITE D
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75604-6321
Mailing Address - Country:US
Mailing Address - Phone:903-234-2990
Mailing Address - Fax:903-234-1752
Practice Address - Street 1:1510 WEST FAIRMONT
Practice Address - Street 2:SUITE D
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75604-6321
Practice Address - Country:US
Practice Address - Phone:903-234-2990
Practice Address - Fax:903-234-1752
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-22
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX22691103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0018LVOtherBLUE CROSS BLUE SHIELD
TX7495514OtherAETNA
TX00653HMedicare ID - Type UnspecifiedPROVIDER IDENTIFICATION