Provider Demographics
NPI:1144347659
Name:MADER, TRISHA LYNN (RN, BSN)
Entity type:Individual
Prefix:MRS
First Name:TRISHA
Middle Name:LYNN
Last Name:MADER
Suffix:
Gender:F
Credentials:RN, BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:DPW-OMHSAS LOGAN BUILDING
Mailing Address - Street 2:P.O. BOX 2675
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17105-2675
Mailing Address - Country:US
Mailing Address - Phone:717-772-7664
Mailing Address - Fax:717-772-7699
Practice Address - Street 1:120 EAST AZALEA DR.
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17110-3594
Practice Address - Country:US
Practice Address - Phone:717-772-7664
Practice Address - Fax:717-772-7699
Is Sole Proprietor?:No
Enumeration Date:2007-03-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN518892L163WA2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA2000XNursing Service ProvidersRegistered NurseAdministrator