Provider Demographics
NPI:1912987595
Name:MAUDLIN, NANCY L (NP)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:L
Last Name:MAUDLIN
Suffix:
Gender:F
Credentials:NP
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:601 JOHN ST
Mailing Address - Street 2:BOX 42
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49007-5341
Mailing Address - Country:US
Mailing Address - Phone:269-341-7806
Mailing Address - Fax:269-341-8743
Practice Address - Street 1:2680 W CENTRE AVE
Practice Address - Street 2:RAMBLING RD PEDIATRICS- PORTAGE
Practice Address - City:PORTAGE
Practice Address - State:MI
Practice Address - Zip Code:49024-4828
Practice Address - Country:US
Practice Address - Phone:269-324-2400
Practice Address - Fax:269-324-0450
Is Sole Proprietor?:No
Enumeration Date:2006-01-19
Last Update Date:2007-11-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI4704100968363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics