Madison Lake-Wickham, RN

Primary specialty

Registered NurseTaxonomy code 163W00000X

License

041519145 Issued in IL

Practice address

1S210 Summit Ave
Oakbrook Terrace, IL 60181-3933

Phone

(630) 282-6004

NPI assigned

May 17, 2022

Last updated

May 17, 2022By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Ms. Madison Lackey Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Registered Nurse

State licenses

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

{
    "created_epoch": "1652745600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1652745600000",
    "number": "1548907934",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1S210 SUMMIT AVE",
            "city": "OAKBROOK TERRACE",
            "state": "IL",
            "postal_code": "601813933"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1S210 SUMMIT AVE",
            "city": "OAKBROOK TERRACE",
            "state": "IL",
            "postal_code": "601813933",
            "telephone_number": "630-282-6004"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LAKE-WICKHAM",
        "first_name": "MADISON",
        "name_prefix": "Ms.",
        "credential": "RN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-05-17",
        "last_updated": "2022-05-17",
        "certification_date": "2022-05-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "IL",
            "license": "041519145",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MADISON",
            "last_name": "LACKEY",
            "prefix": "MS.",
            "credential": "RN",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Kovak Medical Services PC (Kovak Dermatology and Laser Institute)
• Martha Kretzschmar
• Matt J Kriebs, APRN, FNP-BC
• Kristina Lynn Kruskol, PHARMD
• Margaret Bridget Kuchan, PTA
• Neal Laroia, D.D.S.
• Aderemi Lawal
• Sophia Lazzaroni, PA
• Anthony S Leazzo, DO
• Flordeluz M Leonida, APRN

• Registered Nurse in Oakbrook Terrace, IL
• Providers in Oakbrook Terrace, IL by specialty
• Registered Nurse in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 17, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.