Individual provider · Type 1 NPI
Madison Lake, PA-C
Physician Assistant · Grand Forks, ND
Practice location
1108 S 9th St
Grand Forks, ND 58201-5570
Specialties and licenses
| Taxonomy | Code | License |
|---|---|---|
| Physician Assistant Primary | 363A00000X | None listed |
Physician Assistant: A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, orde…
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About NPI 1629656806
Madison Lake, PA-C's National Provider Identifier is 1629656806, issued on Mar 30, 2021. The primary taxonomy on file is Physician Assistant (363A00000X), and the practice location is in Grand Forks, ND. The record was last updated on Jun 19, 2026.