Healthcare Provider Details

I. General information

NPI: 1205607553
Provider Name (Legal Business Name): MADELINE BERNICE DEJONGE KARSTEN BA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/15/2024
Last Update Date: 01/15/2024
Certification Date: 01/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3900 RESERVOIR RD NW
WASHINGTON DC
20007-2126
US

IV. Provider business mailing address

1718 P ST NW APT 920
WASHINGTON DC
20036-1352
US

V. Phone/Fax

Practice location:
  • Phone: 202-687-0100
  • Fax:
Mailing address:
  • Phone: 616-438-4238
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: