Healthcare Provider Details

I. General information

NPI: 1417604513
Provider Name (Legal Business Name): MADE MEDICAL AND AESTHETICS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/08/2022
Last Update Date: 08/21/2026
Certification Date: 08/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4934 LINCOLN DR
EDINA MN
55436-1071
US

IV. Provider business mailing address

4934 LINCOLN DR
EDINA MN
55436-1071
US

V. Phone/Fax

Practice location:
  • Phone: 701-318-6277
  • Fax:
Mailing address:
  • Phone: 701-318-6277
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: JILL DUCHSCHERER
Title or Position: OWNER/MEDICAL DIRECTOR
Credential: FNP-C
Phone: 701-318-6277