Healthcare Provider Details

I. General information

NPI: 1346168879
Provider Name (Legal Business Name): MADELYN LETT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MADELYN SANGSTER

II. Dates (important events)

Enumeration Date: 07/10/2026
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

416 CONNABLE AVE
PETOSKEY MI
49770-2212
US

IV. Provider business mailing address

416 CONNABLE AVE
PETOSKEY MI
49770-2212
US

V. Phone/Fax

Practice location:
  • Phone: 800-248-6777
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number5601013907
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: