Provider Demographics
NPI:1487355632
Name:MADIGAN, DIANA JOYCE
Entity type:Individual
Prefix:
First Name:DIANA
Middle Name:JOYCE
Last Name:MADIGAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1017 CHRISTENSEN AVE
Mailing Address - Street 2:
Mailing Address - City:WEST ST PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55118-1634
Mailing Address - Country:US
Mailing Address - Phone:612-450-3470
Mailing Address - Fax:
Practice Address - Street 1:1017 CHRISTENSEN AVE
Practice Address - Street 2:
Practice Address - City:WEST ST PAUL
Practice Address - State:MN
Practice Address - Zip Code:55118-1634
Practice Address - Country:US
Practice Address - Phone:612-450-3470
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-14
Last Update Date:2023-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist