Healthcare Provider Details

I. General information

NPI: 1093697591
Provider Name (Legal Business Name): MADISON QUINN BADJE CGC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2025
Last Update Date: 07/24/2025
Certification Date: 07/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1513 S 123RD ST
OMAHA NE
68144-1419
US

IV. Provider business mailing address

1513 S 123RD ST
OMAHA NE
68144-1419
US

V. Phone/Fax

Practice location:
  • Phone: 402-717-4200
  • Fax:
Mailing address:
  • Phone: 402-717-4200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code170300000X
TaxonomyGenetic Counselor (M.S.)
License Number501
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: