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1477218279
FAITH ELISE MADDOCK
PORTAGE, MI
NPI
1477218279
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Entity Type
Individual
Gender
Female
Sole Proprietor ?
Yes
Primary Taxonomy
363LF0000X Nurse Practitioner, Family
(Licence: MI 4704378304)
Enumeration Date
2021-11-05
Last Update Date
2021-11-29
Business Address
Ms. FAITH ELISE MADDOCK FNP-BC
3200 W CENTRE AVE STE 203
PORTAGE, MI 49024-4889
Phone number: 269-324-0799
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Mailing Address
Ms. FAITH ELISE MADDOCK FNP-BC
1096 S WILDWOOD AVE
KANKAKEE, IL 60901-5374
Phone number: 630-254-4063
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