Provider Demographics
NPI:1245919869
Name:DUNCAN, MADISEN (PMHNP-BC)
Entity type:Individual
Prefix:
First Name:MADISEN
Middle Name:
Last Name:DUNCAN
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3950 SPARKS DR SE STE 103
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49546-6159
Mailing Address - Country:US
Mailing Address - Phone:616-726-1318
Mailing Address - Fax:
Practice Address - Street 1:3950 SPARKS DR SE STE 103
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-6159
Practice Address - Country:US
Practice Address - Phone:616-726-1318
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-12
Last Update Date:2024-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN34275363LP0808X
MI4704419991363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health