Individual
MADELYN MARIE WALD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
4040 COON RAPIDS BLVD NW STE 120, COON RAPIDS, MN 55433-4568
(763) 236-8174
Mailing address
4040 COON RAPIDS BLVD NW STE 120, COON RAPIDS, MN 55433-4568
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
14122
MN
363AM0700X
Medical Physician Assistant
—
—
Other
Enumeration date
05/27/2022
Last updated
07/25/2022
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