Individual
JERRY LYNN MADSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
RN, FNP-BC
Contact information
Practice address
4720 BURNING TREE RD, DULUTH, MN 55811-2634
(218) 623-1800
(218) 623-1811
Mailing address
113 CEDAR RIDGE DR, CLOQUET, MN 55720-7521
(507) 398-4313
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
R83926-8
MN
163WC1500X
Community Health Registered Nurse
R83926-8
MN
363LF0000X
Family Nurse Practitioner
Primary
R83926-8
MN
Other
Enumeration date
04/20/2012
Last updated
10/10/2017
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