Healthcare Provider Details

I. General information

NPI: 1275444333
Provider Name (Legal Business Name): MADELINE BURBANK
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/16/2026
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

730 E 38TH ST STE 201
MINNEAPOLIS MN
55407-5235
US

IV. Provider business mailing address

730 E 38TH ST STE 201
MINNEAPOLIS MN
55407-5235
US

V. Phone/Fax

Practice location:
  • Phone: 612-547-9707
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number1649767195
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: