Provider Demographics
NPI:1366228611
Name:MADONNA, CECILIA M (MS)
Entity type:Individual
Prefix:
First Name:CECILIA
Middle Name:M
Last Name:MADONNA
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 N BROADWAY ST STE 201
Mailing Address - Street 2:
Mailing Address - City:MOORE
Mailing Address - State:OK
Mailing Address - Zip Code:73160-5135
Mailing Address - Country:US
Mailing Address - Phone:405-990-0816
Mailing Address - Fax:
Practice Address - Street 1:201 N BROADWAY ST STE 201
Practice Address - Street 2:
Practice Address - City:MOORE
Practice Address - State:OK
Practice Address - Zip Code:73160-5135
Practice Address - Country:US
Practice Address - Phone:405-990-0816
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-04
Last Update Date:2023-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator