Provider Demographics
NPI:1750178570
Name:HARBAUM, MADYSON FAYE
Entity type:Individual
Prefix:
First Name:MADYSON
Middle Name:FAYE
Last Name:HARBAUM
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2118 ALLSTATTER AVE
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD TOWNSHIP
Mailing Address - State:OH
Mailing Address - Zip Code:45015-1208
Mailing Address - Country:US
Mailing Address - Phone:513-317-9696
Mailing Address - Fax:
Practice Address - Street 1:2118 ALLSTATTER AVE
Practice Address - Street 2:
Practice Address - City:FAIRFIELD TOWNSHIP
Practice Address - State:OH
Practice Address - Zip Code:45015-1208
Practice Address - Country:US
Practice Address - Phone:513-317-9696
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-23
Last Update Date:2025-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty