Provider Demographics
NPI:1275163750
Name:DUCKWALL, MADOLYNN JON
Entity Type:Individual
Prefix:
First Name:MADOLYNN
Middle Name:JON
Last Name:DUCKWALL
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 1:159 ELIZABETH LN
Mailing Address - Street 2:
Mailing Address - City:BURNSVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55337-2709
Mailing Address - Country:US
Mailing Address - Phone:612-423-7211
Mailing Address - Fax:
Practice Address - Street 1:159 ELIZABETH LN
Practice Address - Street 2:
Practice Address - City:BURNSVILLE
Practice Address - State:MN
Practice Address - Zip Code:55337-2709
Practice Address - Country:US
Practice Address - Phone:612-423-7211
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-23
Last Update Date:2020-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN