Provider Demographics
NPI:1134017437
Name:MADLOCK, DONETTE MICHELE
Entity type:Individual
Prefix:
First Name:DONETTE
Middle Name:MICHELE
Last Name:MADLOCK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1921 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68502-3826
Mailing Address - Country:US
Mailing Address - Phone:402-435-5765
Mailing Address - Fax:
Practice Address - Street 1:8410 PINEDALE AVE
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68520-1146
Practice Address - Country:US
Practice Address - Phone:402-560-9368
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-25
Last Update Date:2025-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant