Provider Demographics
NPI:1003434226
Name:DEMPEWOLF, MADISON WYNNE (FNP, RN)
Entity type:Individual
Prefix:
First Name:MADISON
Middle Name:WYNNE
Last Name:DEMPEWOLF
Suffix:
Gender:F
Credentials:FNP, RN
Other - Prefix:
Other - First Name:MADISON
Other - Middle Name:WYNNE
Other - Last Name:TAYLOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:564 RIO LINDO AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95926-1852
Mailing Address - Country:US
Mailing Address - Phone:530-965-9900
Mailing Address - Fax:
Practice Address - Street 1:564 RIO LINDO AVE STE 102
Practice Address - Street 2:
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95926-1852
Practice Address - Country:US
Practice Address - Phone:530-965-9900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-14
Last Update Date:2020-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95014890363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily