Stacy Madden, RN, CPNP

Primary specialty

Pediatric Nurse PractitionerTaxonomy code 363LP0200X

License

5166712-8900 Issued in UT

Practice address

100 N Mario Capecchi Dr
Salt Lake City, UT 84113-1103

Phone

(801) 662-3600

NPI assigned

Feb 13, 2017

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

Credentials

Certified Pediatric Nurse Practitioner, Registered Nurse

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1486944000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1486944000000",
    "number": "1215476197",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "295 S CHIPETA WAY",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841081287",
            "telephone_number": "801-587-7400"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 N MARIO CAPECCHI DR",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841131103",
            "telephone_number": "801-662-3600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MADDEN",
        "first_name": "STACY",
        "credential": "RN, CPNP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2017-02-13",
        "last_updated": "2017-02-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "UT",
            "license": "5166712-8900",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Susan Elizabeth Macnamara, PH.D.
• Caitlin Alisa Macpherson
• Emily Macpherson, MA CCC-SLP
• Elizabeth Scott Macwilliams, LCSW
• Christine Madden, CSW
• Raija P. Maddock, FNP, APRN
• Robert K Maddock Jr., MD
• Chloe Lorraine Maddox
• Brad Maddy
• Anne Carol Madeo, M.S.

• Pediatric Nurse Practitioner in Salt Lake City, UT
• Providers in Salt Lake City, UT by specialty
• Pediatric Nurse Practitioner in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 13, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.