Individual
MADISON THALACKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-S
Contact information
Practice address
2211 RIVERSIDE AVE, MINNEAPOLIS, MN 55454-1350
(612) 330-1399
Mailing address
1010 SUSSEX DR, EAU CLAIRE, WI 54703-2096
(715) 563-7852
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
—
—
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
05/16/2024
Last updated
05/16/2024
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