Provider Demographics
NPI:1013497833
Name:WILSON, MADDEN (RDN, LDN, CNSC)
Entity Type:Individual
Prefix:MRS
First Name:MADDEN
Middle Name:
Last Name:WILSON
Suffix:
Gender:F
Credentials:RDN, LDN, CNSC
Other - Prefix:
Other - First Name:MADDEN
Other - Middle Name:MARIE
Other - Last Name:HOGAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RDN, LDN, CNSC
Mailing Address - Street 1:1324 WILLMANN LN
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37919-8147
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2100 CLINCH AVE STE 510
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37916-2225
Practice Address - Country:US
Practice Address - Phone:865-546-3998
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-21
Last Update Date:2018-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2836133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered