Madison Stagman
Student in an Organized Health Care Education/Training Program in Mascoutah, IL. Individual provider (NPI-1).
NPI number1164047239
StatusActive
Last updated in NPPESJun 14, 2020
Details
- NPI
- 1164047239
- Entity type
- Individual (NPI-1)
- Name
- Madison Stagman
- Sex
- Female
- Sole proprietor
- No
- Enumeration date
- Jun 14, 2020
- Certification date
- Jun 14, 2020
- Last updated
- Jun 14, 2020
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 390200000X | Student in an Organized Health Care Education/Training Program | – | – | Yes |
| 2255A2300X | Specialist/Technologist, Athletic Trainer | – | – |
Practice location
280 Douglas Ave Apt 4Mascoutah, IL 62258-2963
Phone 608-379-3304
Mailing address
280 Douglas Ave Apt 4Mascoutah, IL 62258-2963
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