MEDICARE: MADALYN MULDOON

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
1	367500000X	Certified Registered Nurse Anesthetist	113448	ND

General Provider Information

NPI Number	:	1558895664
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MADALYN MULDOON

Provider Business Mailing Address
First Line	:	PO BOX 5074
Second Line	:
City	:	SIOUX FALLS
State	:	SD
Zip	:	57117-5074
Country	:	US
Telephone Number	:	605-328-6585
Fax Number	:

Provider Business Practice Location Address
First Line	:	1720 UNIVERSITY DR S
Second Line	:
City	:	FARGO
State	:	ND
Zip	:	58103-4940
Country	:	US
Telephone Number	:	701-234-2000
Fax Number	:	701-234-4938

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/14/2017
Last Update Date	:	05/13/2026

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Directions to “ MADALYN MULDOON ” Practice Location

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