Provider Demographics
NPI:1942063011
Name:NIGHTINGALE, MADISON S (LMT)
Entity Type:Individual
Prefix:
First Name:MADISON
Middle Name:S
Last Name:NIGHTINGALE
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4590 SCOTT TRL STE 110
Mailing Address - Street 2:
Mailing Address - City:EAGAN
Mailing Address - State:MN
Mailing Address - Zip Code:55122-5250
Mailing Address - Country:US
Mailing Address - Phone:651-454-1000
Mailing Address - Fax:651-454-4375
Practice Address - Street 1:4590 SCOTT TRL STE 110
Practice Address - Street 2:
Practice Address - City:EAGAN
Practice Address - State:MN
Practice Address - Zip Code:55122-5250
Practice Address - Country:US
Practice Address - Phone:651-454-1000
Practice Address - Fax:651-454-4375
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-01
Last Update Date:2024-02-01
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist