MEDICARE: MADISON S HENTGEN FNP-C

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	363LF0000X	Family Nurse Practitioner	28230203A	IN

General Provider Information

NPI Number	:	1780525709
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MADISON S HENTGEN FNP-C

Provider Business Mailing Address
First Line	:	3500 FRANCISCAN WAY
Second Line	:
City	:	MICHIGAN CITY
State	:	IN
Zip	:	46360-0033
Country	:	US
Telephone Number	:	219-392-7084
Fax Number	:	219-703-6854

Provider Business Practice Location Address
First Line	:	3500 FRANCISCAN WAY
Second Line	:
City	:	MICHIGAN CITY
State	:	IN
Zip	:	46360-0033
Country	:	US
Telephone Number	:	219-877-1616
Fax Number	:

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

Provider Enumeration Date	:	04/03/2026
Last Update Date	:	05/12/2026

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