Provider Demographics
NPI:1336835800
Name:BURNS, MADISSEN MARIE
Entity Type:Individual
Prefix:
First Name:MADISSEN
Middle Name:MARIE
Last Name:BURNS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15510 30TH ST
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:MN
Mailing Address - Zip Code:55388-5700
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:15510 30TH ST
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:MN
Practice Address - Zip Code:55388-5700
Practice Address - Country:US
Practice Address - Phone:612-272-1636
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-17
Last Update Date:2023-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program