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General NPI Number Information
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NPI Number | 1184740664
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Entity Type | Individual
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Provider Name | MADONNA KATHRYN MCDERMOTT CNP
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Gender | Female
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Dates
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Enumeration Date | 03/22/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 2115 SUMMIT AVE MAIL BOX 5056
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City | SAINT PAUL
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State | MN
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Zip | 55105-1048
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Country | US
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Telephone | 651-962-6750
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Fax |
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Provider Business Mailing Address
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Address Line | 1567 DUNLAP ST N
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City | SAINT PAUL
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State | MN
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Zip | 55108-2215
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Country | US
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Telephone | 651-487-3707
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | R-122604-5
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License Number State | MN
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