Provider Demographics
NPI:1831478254
Name:MADSEN, BRIANNE MICHELLE (PA-C)
Entity Type:Individual
Prefix:
First Name:BRIANNE
Middle Name:MICHELLE
Last Name:MADSEN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1505 MEDICAL PKWY
Mailing Address - Street 2:
Mailing Address - City:CARSON CITY
Mailing Address - State:NV
Mailing Address - Zip Code:89703-4634
Mailing Address - Country:US
Mailing Address - Phone:775-883-7811
Mailing Address - Fax:775-883-7871
Practice Address - Street 1:1505 MEDICAL PKWY
Practice Address - Street 2:
Practice Address - City:CARSON CITY
Practice Address - State:NV
Practice Address - Zip Code:89703-4634
Practice Address - Country:US
Practice Address - Phone:775-883-7811
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-16
Last Update Date:2023-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV01042472133V00000X
NVPA2350363AM0700X
NVPA-2350207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical