Provider Demographics
NPI:1659188464
Name:MADERA, MARILYN (FNP-C)
Entity type:Individual
Prefix:
First Name:MARILYN
Middle Name:
Last Name:MADERA
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4025 S RIVERPOINT PKWY
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85040-0723
Mailing Address - Country:US
Mailing Address - Phone:844-937-8679
Mailing Address - Fax:844-937-8679
Practice Address - Street 1:4025 S RIVERPOINT PKWY
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85040-0723
Practice Address - Country:US
Practice Address - Phone:844-937-8679
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-16
Last Update Date:2025-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ317440363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily