Provider Demographics
NPI:1629899893
Name:ALBERTS, MADISON (NP)
Entity type:Individual
Prefix:
First Name:MADISON
Middle Name:
Last Name:ALBERTS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:MADISON
Other - Middle Name:
Other - Last Name:BAYLISS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:1235 N MULFORD RD STE 205
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61107-3879
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1235 N MULFORD RD STE 205
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61107-3879
Practice Address - Country:US
Practice Address - Phone:815-484-9900
Practice Address - Fax:815-487-4949
Is Sole Proprietor?:No
Enumeration Date:2024-10-21
Last Update Date:2024-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209030799363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner