Healthcare Provider Details

I. General information

NPI: 1306759642
Provider Name (Legal Business Name): JONATHAN MADSEN RN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2026
Last Update Date: 09/28/2026
Certification Date: 09/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 CRATER LAKE AVE
MEDFORD OR
97504-6241
US

IV. Provider business mailing address

1111 CRATER LAKE AVE
MEDFORD OR
97504-6241
US

V. Phone/Fax

Practice location:
  • Phone: 541-732-5000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SP2800X
TaxonomyPerioperative Clinical Nurse Specialist
License Number202211308RN
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: