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NPI Code Detail

MEDICARE: JERRY LYNN MADSEN RN, FNP-BC

MEDICARE: JERRY LYNN MADSEN RN, FNP-BC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1163W00000XRegistered NurseR83926-8MN
2163WC1500XCommunity Health Registered NurseR83926-8MN
3363LF0000XFamily Nurse PractitionerR83926-8MN

General Provider Information

NPI Number : 1144587650
Entity Type Code : Individual
Provider Name (Legal Business Name) : JERRY LYNN MADSEN RN, FNP-BC
Provider Business Mailing Address
First Line : 113 CEDAR RIDGE DR
Second Line :
City : CLOQUET
State : MN
Zip : 55720-7521
Country : US
Telephone Number : 507-398-4313
Fax Number :
Provider Business Practice Location Address
First Line : 4720 BURNING TREE RD
Second Line :
City : DULUTH
State : MN
Zip : 55811-2634
Country : US
Telephone Number : 218-623-1800
Fax Number : 218-623-1811
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/20/2012
Last Update Date : 10/10/2017

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