Provider Demographics
NPI:1023722527
Name:STYRLUND, MADISON YVETTE (PA)
Entity type:Individual
Prefix:
First Name:MADISON
Middle Name:YVETTE
Last Name:STYRLUND
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9445 OLYMPIA DR
Mailing Address - Street 2:
Mailing Address - City:EDEN PRAIRIE
Mailing Address - State:MN
Mailing Address - Zip Code:55347-2845
Mailing Address - Country:US
Mailing Address - Phone:952-452-0076
Mailing Address - Fax:
Practice Address - Street 1:2700 VIKINGS CIR
Practice Address - Street 2:
Practice Address - City:EAGAN
Practice Address - State:MN
Practice Address - Zip Code:55121-1002
Practice Address - Country:US
Practice Address - Phone:952-456-7600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-09
Last Update Date:2023-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1164474250207X00000X
MN363A00000X
MN14365363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1200593OtherNCCPA