Provider Demographics
NPI:1467288043
Name:PETERSEN, MADISON NICOLE (PA-C)
Entity type:Individual
Prefix:
First Name:MADISON
Middle Name:NICOLE
Last Name:PETERSEN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:920 N YORK RD STE 100
Mailing Address - Street 2:
Mailing Address - City:HINSDALE
Mailing Address - State:IL
Mailing Address - Zip Code:60521-3515
Mailing Address - Country:US
Mailing Address - Phone:312-319-1978
Mailing Address - Fax:312-262-7791
Practice Address - Street 1:737 N MICHIGAN AVE STE 720
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-6661
Practice Address - Country:US
Practice Address - Phone:312-319-1978
Practice Address - Fax:312-262-7791
Is Sole Proprietor?:No
Enumeration Date:2024-09-11
Last Update Date:2025-01-11
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant