Provider Demographics
NPI:1720972268
Name:MCKINNON, MADISON LESLIE (RN)
Entity type:Individual
Prefix:
First Name:MADISON
Middle Name:LESLIE
Last Name:MCKINNON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:MADISON
Other - Middle Name:LESLIE
Other - Last Name:JONES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:3848 HARRISON BLVD
Mailing Address - Street 2:
Mailing Address - City:OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84408-0001
Mailing Address - Country:US
Mailing Address - Phone:801-626-6000
Mailing Address - Fax:
Practice Address - Street 1:3848 HARRISON BLVD
Practice Address - Street 2:
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84408-0001
Practice Address - Country:US
Practice Address - Phone:801-626-6000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-09
Last Update Date:2025-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program