Provider Demographics
NPI:1518699867
Name:KLAYSMAT, MADELINE (PA-C)
Entity Type:Individual
Prefix:
First Name:MADELINE
Middle Name:
Last Name:KLAYSMAT
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:800 FREEPORT AVE NW
Mailing Address - Street 2:
Mailing Address - City:ELK RIVER
Mailing Address - State:MN
Mailing Address - Zip Code:55330-2723
Mailing Address - Country:US
Mailing Address - Phone:763-581-5200
Mailing Address - Fax:763-581-5201
Practice Address - Street 1:800 FREEPORT AVE NW
Practice Address - Street 2:
Practice Address - City:ELK RIVER
Practice Address - State:MN
Practice Address - Zip Code:55330-2723
Practice Address - Country:US
Practice Address - Phone:763-581-5200
Practice Address - Fax:763-581-5201
Is Sole Proprietor?:No
Enumeration Date:2022-06-27
Last Update Date:2024-05-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN14860363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant