Provider Demographics
NPI:1952793408
Name:MADDEN, NICHELLE (DO)
Entity Type:Individual
Prefix:
First Name:NICHELLE
Middle Name:
Last Name:MADDEN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:NICHELLE
Other - Middle Name:
Other - Last Name:ARNOLD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5056 N CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85012-1521
Mailing Address - Country:US
Mailing Address - Phone:602-222-9111
Mailing Address - Fax:602-222-9333
Practice Address - Street 1:5056 N CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85012-1521
Practice Address - Country:US
Practice Address - Phone:602-222-9111
Practice Address - Fax:602-222-9333
Is Sole Proprietor?:No
Enumeration Date:2015-02-20
Last Update Date:2020-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS1482207N00000X
AZ008662207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology