| NPI | 1639267669 |
|---|---|
| Former Name | MADELENE RENEE CARROLL |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: SC 28863) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: SC ll28863) |
| Enumeration Date | 2006-10-11 |
| Last Update Date | 2020-10-22 |