Provider Demographics
NPI:1568463883
Name:MADSEN, TAMMY M (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:TAMMY
Middle Name:M
Last Name:MADSEN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:502 N 9TH AVE
Mailing Address - Street 2:
Mailing Address - City:VINTON
Mailing Address - State:IA
Mailing Address - Zip Code:52349-2299
Mailing Address - Country:US
Mailing Address - Phone:319-472-6215
Mailing Address - Fax:319-472-6483
Practice Address - Street 1:200 HAWKINS DR
Practice Address - Street 2:
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52242-1009
Practice Address - Country:US
Practice Address - Phone:319-356-3850
Practice Address - Fax:319-356-3900
Is Sole Proprietor?:No
Enumeration Date:2005-08-09
Last Update Date:2020-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA001367363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA42174OtherWELLMARK BC/BS
IA42174OtherWELLMARK BC/BS
P44218Medicare UPIN