Healthcare Provider Details

I. General information

NPI: 1194305102
Provider Name (Legal Business Name): MADISON BARENSE LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2021
Last Update Date: 06/30/2025
Certification Date: 06/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

894 W 24TH ST
HOLLAND MI
49423-4575
US

IV. Provider business mailing address

894 W 24TH ST
HOLLAND MI
49423-4575
US

V. Phone/Fax

Practice location:
  • Phone: 616-796-4347
  • Fax:
Mailing address:
  • Phone: 616-796-4347
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number7501014114
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number StateMI
# 3
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: