Provider Demographics
NPI:1366248635
Name:HART-MADDUX, FAYE ILENE
Entity type:Individual
Prefix:
First Name:FAYE
Middle Name:ILENE
Last Name:HART-MADDUX
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9055 ROAD 109A
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:NE
Mailing Address - Zip Code:69336-2629
Mailing Address - Country:US
Mailing Address - Phone:308-279-2179
Mailing Address - Fax:
Practice Address - Street 1:9055 ROAD 109A
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:NE
Practice Address - Zip Code:69336-2629
Practice Address - Country:US
Practice Address - Phone:308-279-2179
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-19
Last Update Date:2025-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion