Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Madison Lake, PA-C

Individual provider Physician Assistant · NPI 1629656806

Madison Lake, PA-C is a Physician Assistant in Grand Forks, North Dakota. Registered with an NPI since 2021.

In the registry since
2021
What do these letters mean?
PA-C — Physician Assistant, Certified
A physician assistant who holds current national certification.

See every abbreviation used in this directory →

Practice location Address checks out

1108 S 9th St
Grand Forks, ND 58201-5570
Phone: (218) 689-9517
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X

Record details

NPI number1629656806
Entity typeIndividual (Type 1)
GenderFemale
Credentials PA-C
Sole proprietorNo
NPI enumeratedMarch 30, 2021
Last updated in NPPESJune 19, 2026
Certification dateJune 19, 2026

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