Provider Demographics
NPI:1134235252
Name:MADIGAN, LINDA JEAN (CRNA)
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:JEAN
Last Name:MADIGAN
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3830 W FRONT ST
Mailing Address - Street 2:
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49684-8153
Mailing Address - Country:US
Mailing Address - Phone:231-929-2500
Mailing Address - Fax:231-929-4365
Practice Address - Street 1:3830 W FRONT ST
Practice Address - Street 2:
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49684-8153
Practice Address - Country:US
Practice Address - Phone:231-929-2500
Practice Address - Fax:231-929-4365
Is Sole Proprietor?:No
Enumeration Date:2006-08-22
Last Update Date:2012-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704108203367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0M58250OtherMEDICARE GROUP
MI430B810310OtherBCBS
MI493908510Medicaid
MICG1308OtherMEDICARE RR
MI0M58250OtherMEDICARE GROUP
MI493908510Medicaid