Provider Demographics
NPI:1750181350
Name:MORAN, MADISON (AGNP-C)
Entity type:Individual
Prefix:
First Name:MADISON
Middle Name:
Last Name:MORAN
Suffix:
Gender:
Credentials:AGNP-C
Other - Prefix:
Other - First Name:MADISON
Other - Middle Name:
Other - Last Name:MYERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AGNP-C
Mailing Address - Street 1:1529 CHORD DR
Mailing Address - Street 2:
Mailing Address - City:WENDELL
Mailing Address - State:NC
Mailing Address - Zip Code:27591-3350
Mailing Address - Country:US
Mailing Address - Phone:717-968-2285
Mailing Address - Fax:
Practice Address - Street 1:10941 RAVEN RIDGE RD STE 103
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27614-6487
Practice Address - Country:US
Practice Address - Phone:919-870-6066
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-14
Last Update Date:2025-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCAG10240003363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology