Provider Demographics
NPI:1871935908
Name:LOTT, MADELAINE (NP)
Entity type:Individual
Prefix:MRS
First Name:MADELAINE
Middle Name:
Last Name:LOTT
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MS
Other - First Name:MADELAINE
Other - Middle Name:MARIE
Other - Last Name:DOSS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:210 FIELDSTOWN RD
Mailing Address - Street 2:SUITE 124
Mailing Address - City:GARDENDALE
Mailing Address - State:AL
Mailing Address - Zip Code:35071-2408
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:210 FIELDSTOWN RD
Practice Address - Street 2:SUITE 124
Practice Address - City:GARDENDALE
Practice Address - State:AL
Practice Address - Zip Code:35071-2408
Practice Address - Country:US
Practice Address - Phone:815-713-2600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-17
Last Update Date:2014-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-122739363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner