Provider Demographics
NPI:1932479870
Name:MADSEN, DEON DENISE (IDMT)
Entity Type:Individual
Prefix:
First Name:DEON
Middle Name:DENISE
Last Name:MADSEN
Suffix:
Gender:F
Credentials:IDMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4880 N SABINO CANYON RD
Mailing Address - Street 2:#17176
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:58750
Mailing Address - Country:US
Mailing Address - Phone:520-309-8216
Mailing Address - Fax:
Practice Address - Street 1:4880 N SABINO CANYON RD
Practice Address - Street 2:#17176
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:58750
Practice Address - Country:US
Practice Address - Phone:520-309-8216
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-10
Last Update Date:2012-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1003XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Medical Technicians