Provider Demographics
NPI:1023421344
Name:MADDEN, JODY LYNN (CRNP)
Entity type:Individual
Prefix:MS
First Name:JODY
Middle Name:LYNN
Last Name:MADDEN
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:MS
Other - First Name:JODY
Other - Middle Name:LYNN
Other - Last Name:MADDEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNP
Mailing Address - Street 1:2000 CLIFFMINE RD STE 500
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15275-1053
Mailing Address - Country:US
Mailing Address - Phone:878-201-3312
Mailing Address - Fax:
Practice Address - Street 1:2000 CLIFFMINE RD STE 500
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15275-1053
Practice Address - Country:US
Practice Address - Phone:878-201-3312
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-04
Last Update Date:2024-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC27907363LP0808X
PASP021525363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1023421344OtherPACE ORGANIZATION