Provider Demographics
NPI:1932110996
Name:MADIGAN, MARY MICHELE (CNP)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:MICHELE
Last Name:MADIGAN
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
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Mailing Address - Street 1:1409 ASHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55104-6707
Mailing Address - Country:US
Mailing Address - Phone:651-644-6234
Mailing Address - Fax:
Practice Address - Street 1:1 VETERANS DR
Practice Address - Street 2:MEDICINE CLINIC 1A
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55417-2309
Practice Address - Country:US
Practice Address - Phone:612-467-1836
Practice Address - Fax:612-727-5948
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR 061153-8363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNVA D000Medicare UPIN