Provider Demographics
NPI:1871219923
Name:KIRSCH, MADISON (PMHNP)
Entity type:Individual
Prefix:
First Name:MADISON
Middle Name:
Last Name:KIRSCH
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:425 E AVENUE C
Mailing Address - Street 2:
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58501-3942
Mailing Address - Country:US
Mailing Address - Phone:701-712-9962
Mailing Address - Fax:701-354-2219
Practice Address - Street 1:425 E AVENUE C
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58501-3942
Practice Address - Country:US
Practice Address - Phone:701-712-9962
Practice Address - Fax:701-354-2219
Is Sole Proprietor?:No
Enumeration Date:2022-10-19
Last Update Date:2022-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDR46045363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health