Provider Demographics
NPI:1669183893
Name:CORNWELL, MADISON NICOLE (FNP)
Entity type:Individual
Prefix:
First Name:MADISON
Middle Name:NICOLE
Last Name:CORNWELL
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1701 N NELSON ST
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22207-3626
Mailing Address - Country:US
Mailing Address - Phone:540-550-7779
Mailing Address - Fax:
Practice Address - Street 1:4833 RUGBY AVE STE 400
Practice Address - Street 2:
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20814-3915
Practice Address - Country:US
Practice Address - Phone:540-550-7779
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-08
Last Update Date:2022-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024184058363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily