Provider Demographics
NPI:1831769348
Name:PHEE, MADISON MARIE (AGACNP-BC)
Entity type:Individual
Prefix:
First Name:MADISON
Middle Name:MARIE
Last Name:PHEE
Suffix:
Gender:F
Credentials:AGACNP-BC
Other - Prefix:
Other - First Name:MADISON
Other - Middle Name:
Other - Last Name:WILSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:NP
Mailing Address - Street 1:4160 JOHN R ST STE 925
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48201-2017
Mailing Address - Country:US
Mailing Address - Phone:313-745-7247
Mailing Address - Fax:313-993-0500
Practice Address - Street 1:4160 JOHN R ST STE 925
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48201-2017
Practice Address - Country:US
Practice Address - Phone:313-745-7247
Practice Address - Fax:313-993-0500
Is Sole Proprietor?:No
Enumeration Date:2021-06-28
Last Update Date:2024-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704339193363LA2100X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care