Provider Demographics
NPI:1013965557
Name:EWART-MADHERE, ARLENE ELAINE (FNP)
Entity type:Individual
Prefix:MRS
First Name:ARLENE
Middle Name:ELAINE
Last Name:EWART-MADHERE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6000 FAIRFIELD ESTATES DR
Mailing Address - Street 2:
Mailing Address - City:LITHONIA
Mailing Address - State:GA
Mailing Address - Zip Code:30058-8345
Mailing Address - Country:US
Mailing Address - Phone:404-374-2171
Mailing Address - Fax:
Practice Address - Street 1:866 DUNN AVE
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32218-4803
Practice Address - Country:US
Practice Address - Phone:866-825-3227
Practice Address - Fax:904-380-2905
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2011-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN129054363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily