Healthcare Provider Details

I. General information

NPI: 1700793270
Provider Name (Legal Business Name): MADISEN ANDERSEN RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/27/2026
Last Update Date: 08/27/2026
Certification Date: 08/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

236 RIVER VISTA PL
TWIN FALLS ID
83301-3006
US

IV. Provider business mailing address

137 ASH ST APT 4
TWIN FALLS ID
83301-7259
US

V. Phone/Fax

Practice location:
  • Phone: 208-737-5255
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number13983500-9920
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: