Provider Demographics
NPI:1265060479
Name:RIELS, MADELYN ROSE (DO)
Entity type:Individual
Prefix:
First Name:MADELYN
Middle Name:ROSE
Last Name:RIELS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:MADELYN
Other - Middle Name:ROSE
Other - Last Name:BAGWELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1200 CELEBRITY DR
Mailing Address - Street 2:
Mailing Address - City:RUSTON
Mailing Address - State:LA
Mailing Address - Zip Code:71270-3893
Mailing Address - Country:US
Mailing Address - Phone:318-254-2113
Mailing Address - Fax:
Practice Address - Street 1:1200 CELEBRITY DR
Practice Address - Street 2:
Practice Address - City:RUSTON
Practice Address - State:LA
Practice Address - Zip Code:71270-3893
Practice Address - Country:US
Practice Address - Phone:318-254-2113
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-01
Last Update Date:2024-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDO5088207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine