MEDICARE: KAREN MADIGAN CRNA

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	219867-4406	UT

General Provider Information

NPI Number	:	1740213602
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAREN MADIGAN CRNA

Provider Business Mailing Address
First Line	:	285 CRESTVIEW DR
Second Line	:
City	:	PARK CITY
State	:	UT
Zip	:	84098-5119
Country	:	US
Telephone Number	:	435-615-7236
Fax Number	:

Provider Business Practice Location Address
First Line	:	3715 W 4100 S
Second Line	:
City	:	WEST VALLEY CITY
State	:	UT
Zip	:	84120-5537
Country	:	US
Telephone Number	:	801-993-9526
Fax Number	:

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

Provider Enumeration Date	:	07/07/2006
Last Update Date	:	07/08/2007

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