Provider Demographics
NPI:1720608847
Name:AUTEN, MADISON
Entity Type:Individual
Prefix:
First Name:MADISON
Middle Name:
Last Name:AUTEN
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 1:12850 E MONTVIEW BLVD # V20-1218
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80045-2605
Mailing Address - Country:US
Mailing Address - Phone:913-731-2377
Mailing Address - Fax:
Practice Address - Street 1:12850 E MONTVIEW BLVD # V20-1218
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80045-2605
Practice Address - Country:US
Practice Address - Phone:913-731-2377
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-18
Last Update Date:2020-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program