Provider Demographics
NPI:1912533555
Name:STEFFENSEN, MADELINE AMELIA (PNP)
Entity Type:Individual
Prefix:
First Name:MADELINE
Middle Name:AMELIA
Last Name:STEFFENSEN
Suffix:
Gender:F
Credentials:PNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1506 KLONDIKE RD SW STE 205
Mailing Address - Street 2:
Mailing Address - City:CONYERS
Mailing Address - State:GA
Mailing Address - Zip Code:30094-5173
Mailing Address - Country:US
Mailing Address - Phone:678-750-4000
Mailing Address - Fax:678-750-4005
Practice Address - Street 1:1506 KLONDIKE RD SW STE 205
Practice Address - Street 2:
Practice Address - City:CONYERS
Practice Address - State:GA
Practice Address - Zip Code:30094-5173
Practice Address - Country:US
Practice Address - Phone:678-750-4000
Practice Address - Fax:678-750-4005
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-16
Last Update Date:2020-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN281025363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatricsGroup - Single Specialty