Provider Demographics
NPI:1053960062
Name:ELING, MADELYN K
Entity type:Individual
Prefix:
First Name:MADELYN
Middle Name:K
Last Name:ELING
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6020 HOLTON WHITEHALL RD
Mailing Address - Street 2:
Mailing Address - City:HOLTON
Mailing Address - State:MI
Mailing Address - Zip Code:49425-8593
Mailing Address - Country:US
Mailing Address - Phone:231-206-1748
Mailing Address - Fax:
Practice Address - Street 1:6020 HOLTON WHITEHALL RD
Practice Address - Street 2:
Practice Address - City:HOLTON
Practice Address - State:MI
Practice Address - Zip Code:49425-8593
Practice Address - Country:US
Practice Address - Phone:231-206-1748
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-11
Last Update Date:2019-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider