Provider Demographics
NPI:1952907479
Name:PERKINS, MADELON CAROL (FNP-C)
Entity Type:Individual
Prefix:
First Name:MADELON
Middle Name:CAROL
Last Name:PERKINS
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:MADELON
Other - Middle Name:CAROL
Other - Last Name:EVENSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:12707 W CARAVEO PL
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85383-8067
Mailing Address - Country:US
Mailing Address - Phone:623-810-9659
Mailing Address - Fax:
Practice Address - Street 1:12707 W CARAVEO PL
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85383-8067
Practice Address - Country:US
Practice Address - Phone:623-810-9659
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-09
Last Update Date:2020-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ250714363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZD01467208OtherDRIVER LICENSE