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NPI Code Detail

MEDICARE: GINA MADSEN APRN

MEDICARE: GINA MADSEN APRN
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
1363LF0000XFamily Nurse PractitionerAP3860AZ

General Provider Information

NPI Number : 1477521821
Entity Type Code : Individual
Provider Name (Legal Business Name) : GINA MADSEN APRN
Provider Business Mailing Address
First Line : 648 E SUN VALLEY FARMS LN
Second Line :
City : SAN TAN VALLEY
State : AZ
Zip : 85140-4258
Country : US
Telephone Number : 603-724-3503
Fax Number :
Provider Business Practice Location Address
First Line : 6015 E BROWN RD
Second Line :
City : MESA
State : AZ
Zip : 85205-4452
Country : US
Telephone Number : 603-724-3503
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/10/2006
Last Update Date : 11/14/2012

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