Provider Demographics
NPI:1629607312
Name:OFERT, MADISON JADE
Entity Type:Individual
Prefix:
First Name:MADISON
Middle Name:JADE
Last Name:OFERT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MADISON
Other - Middle Name:JADE
Other - Last Name:DAVIS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:3001 29TH ST W APT 115
Mailing Address - Street 2:
Mailing Address - City:WILLISTON
Mailing Address - State:ND
Mailing Address - Zip Code:58801-3597
Mailing Address - Country:US
Mailing Address - Phone:701-580-9252
Mailing Address - Fax:
Practice Address - Street 1:3001 29TH ST W APT 115
Practice Address - Street 2:
Practice Address - City:WILLISTON
Practice Address - State:ND
Practice Address - Zip Code:58801-3597
Practice Address - Country:US
Practice Address - Phone:701-580-9252
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-03
Last Update Date:2020-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula