Provider Demographics
NPI:1447641659
Name:MADRON, LINDA SUE (CNA)
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:SUE
Last Name:MADRON
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:MRS
Other - First Name:LINDA
Other - Middle Name:SUE
Other - Last Name:MADRON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CNA
Mailing Address - Street 1:PO BOX 538
Mailing Address - Street 2:
Mailing Address - City:WEWOKA
Mailing Address - State:OK
Mailing Address - Zip Code:74884-0538
Mailing Address - Country:US
Mailing Address - Phone:405-221-7031
Mailing Address - Fax:
Practice Address - Street 1:2307 GORDON COOPER DR
Practice Address - Street 2:
Practice Address - City:SHAWNEE
Practice Address - State:OK
Practice Address - Zip Code:74801-9007
Practice Address - Country:US
Practice Address - Phone:405-273-5236
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-10
Last Update Date:2015-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK37V980990610261QC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health