Provider Demographics
NPI:1356124283
Name:WAUSON, MADELYN MARY
Entity type:Individual
Prefix:
First Name:MADELYN
Middle Name:MARY
Last Name:WAUSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1235 SW MERCHANT ST APT 104
Mailing Address - Street 2:
Mailing Address - City:ANKENY
Mailing Address - State:IA
Mailing Address - Zip Code:50023-2488
Mailing Address - Country:US
Mailing Address - Phone:469-396-8342
Mailing Address - Fax:
Practice Address - Street 1:2825 S ANKENY BLVD
Practice Address - Street 2:
Practice Address - City:ANKENY
Practice Address - State:IA
Practice Address - Zip Code:50023-9417
Practice Address - Country:US
Practice Address - Phone:515-598-7200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-15
Last Update Date:2023-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374700000XNursing Service Related ProvidersTechnician