Individual provider · NPI-1

Madison Fagerlie

Emergency Medicine · Peoria, AZ

NPI number1639922370
StatusActive
Last updated in NPPESSep 9, 2026

Details

NPI
1639922370
Entity type
Individual (NPI-1)
Name
Madison Fagerlie
Sex
Female
Sole proprietor
No
Enumeration date
Apr 11, 2024
Certification date
Sep 9, 2026
Last updated
Sep 9, 2026

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
207P00000X Emergency Medicine012634AZYes
390200000X Student in an Organized Health Care Education/Training Program––

Practice location

24998 N 74th Ave
Peoria, AZ 85383-6325

Phone 623-853-3428

Mailing address

24998 N 74th Ave
Peoria, AZ 85383-6325

Phone 623-853-3428

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