Provider Demographics
NPI:1265037741
Name:MADSEN, BRANDON (CRNA)
Entity type:Individual
Prefix:
First Name:BRANDON
Middle Name:
Last Name:MADSEN
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1224 8TH ST
Mailing Address - Street 2:
Mailing Address - City:RUPERT
Mailing Address - State:ID
Mailing Address - Zip Code:83350-1599
Mailing Address - Country:US
Mailing Address - Phone:208-436-0481
Mailing Address - Fax:208-436-6038
Practice Address - Street 1:1224 8TH ST
Practice Address - Street 2:
Practice Address - City:RUPERT
Practice Address - State:ID
Practice Address - Zip Code:83350-1599
Practice Address - Country:US
Practice Address - Phone:208-436-0481
Practice Address - Fax:208-436-6038
Is Sole Proprietor?:No
Enumeration Date:2020-12-02
Last Update Date:2025-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6382424-3102163W00000X
WY47281367500000X
ID79700367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse