Provider Demographics
NPI:1386689040
Name:MADSEN, REBECCA L (APRN,CRNA, DNP)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:L
Last Name:MADSEN
Suffix:
Gender:F
Credentials:APRN,CRNA, DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55415-1623
Mailing Address - Country:US
Mailing Address - Phone:612-873-6005
Mailing Address - Fax:612-630-8242
Practice Address - Street 1:701 PARK AVE
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55415-1623
Practice Address - Country:US
Practice Address - Phone:612-873-3152
Practice Address - Fax:612-904-4218
Is Sole Proprietor?:No
Enumeration Date:2006-06-18
Last Update Date:2016-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN038142367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN8T944GOOtherBLUE CROSS BLUE SHIELD
MN749542100Medicaid
MN749542100Medicaid
MN430001589Medicare Oscar/Certification