Provider Demographics
NPI:1518946318
Name:MADDEN, KATHLEEN L (RN, CNP)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:L
Last Name:MADDEN
Suffix:
Gender:F
Credentials:RN, CNP
Other - Prefix:
Other - First Name:KATHLEEN
Other - Middle Name:L
Other - Last Name:CHAPMAN, HUTCHEISON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN, CNP
Mailing Address - Street 1:1000 E 1ST ST STE 203
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55805-2297
Mailing Address - Country:US
Mailing Address - Phone:218-249-6450
Mailing Address - Fax:218-249-6451
Practice Address - Street 1:1000 E 1ST ST STE 203
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55805
Practice Address - Country:US
Practice Address - Phone:218-249-6450
Practice Address - Fax:218-249-6451
Is Sole Proprietor?:No
Enumeration Date:2006-01-11
Last Update Date:2020-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR 099297-2363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN131637100Medicaid
MNQ28577Medicare UPIN