Healthcare Provider Details

I. General information

NPI: 1235801473
Provider Name (Legal Business Name): MADELINE NICOLE ORR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2021
Last Update Date: 04/22/2022
Certification Date: 04/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10450 185TH ST W
LAKEVILLE MN
55044-6686
US

IV. Provider business mailing address

1813 JEFFERSON RD
NORTHFIELD MN
55057-3155
US

V. Phone/Fax

Practice location:
  • Phone: 612-509-1283
  • Fax:
Mailing address:
  • Phone: 507-301-8102
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: