Provider Demographics
NPI:1275225468
Name:MADSON, CHRISTIAN GHILLIAM (DNP, APRN)
Entity type:Individual
Prefix:
First Name:CHRISTIAN
Middle Name:GHILLIAM
Last Name:MADSON
Suffix:
Gender:F
Credentials:DNP, APRN
Other - Prefix:
Other - First Name:CHRISTIAN
Other - Middle Name:GHILLIAM
Other - Last Name:MATHIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3360 10TH AVE S
Mailing Address - Street 2:
Mailing Address - City:GREAT FALLS
Mailing Address - State:MT
Mailing Address - Zip Code:59405-3451
Mailing Address - Country:US
Mailing Address - Phone:406-771-8182
Mailing Address - Fax:
Practice Address - Street 1:3360 10TH AVE S
Practice Address - Street 2:
Practice Address - City:GREAT FALLS
Practice Address - State:MT
Practice Address - Zip Code:59405-3451
Practice Address - Country:US
Practice Address - Phone:406-771-8182
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-24
Last Update Date:2024-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT217058363LP0808X
MT28048163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse