Provider Demographics
NPI:1508743287
Name:MADDOX, CORTRELL LIGEL SR (CNA)
Entity type:Individual
Prefix:
First Name:CORTRELL
Middle Name:LIGEL
Last Name:MADDOX
Suffix:SR
Gender:M
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3300 SE GLENSTONE DR UNIT 4
Mailing Address - Street 2:
Mailing Address - City:GRIMES
Mailing Address - State:IA
Mailing Address - Zip Code:50111-5084
Mailing Address - Country:US
Mailing Address - Phone:515-402-8762
Mailing Address - Fax:
Practice Address - Street 1:6310 NW 106TH ST APT 111
Practice Address - Street 2:
Practice Address - City:JOHNSTON
Practice Address - State:IA
Practice Address - Zip Code:50131-2465
Practice Address - Country:US
Practice Address - Phone:515-402-8762
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-16
Last Update Date:2025-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health