Provider Demographics
NPI:1003788258
Name:VAN WINKLE, MADISON LYNN (PA-C)
Entity type:Individual
Prefix:
First Name:MADISON
Middle Name:LYNN
Last Name:VAN WINKLE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1151 W MILHAM AVE UNIT 758
Mailing Address - Street 2:
Mailing Address - City:PORTAGE
Mailing Address - State:MI
Mailing Address - Zip Code:49081-5032
Mailing Address - Country:US
Mailing Address - Phone:516-710-0979
Mailing Address - Fax:
Practice Address - Street 1:1151 W MILHAM AVE UNIT 758
Practice Address - Street 2:
Practice Address - City:PORTAGE
Practice Address - State:MI
Practice Address - Zip Code:49081-5032
Practice Address - Country:US
Practice Address - Phone:516-710-0979
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-09-18
Last Update Date:2025-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601013503APP25363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant