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Recently Updated NPI Information — some details in this NPI profile have been updated in the NPI registry within the last 60 days.

MADISON LAKE PA-C
NPI 1629656806
Physician Assistant in Grand Forks, ND

Active since March 30, 2021
1108 S 9TH ST, GRAND FORKS, ND 58201(218) 689-9517 Get Directions Write a Review

NPPES record last updated: June 19, 2026. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Madison Lake Pa-c NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MADISON LAKE PA-C (NPI 1629656806) is an individual physician assistant in Grand Forks, North Dakota and active in the NPI registry since March 2021.

NPPES Registry Identity

NPI1629656806
Entity TypeIndividualFemale
Primary Taxonomy363A00000X
Provider Legal NameMADISON LAKECredential: PA-C
Location Address1108 S 9TH STGrand Forks, ND 58201-5570
Mailing Address1108 S 9th StGrand Forks, ND 58201-5570 · (218) 689-9517
Phone(218) 689-9517
Sole ProprietorNo
Enumeration DateMarch 30, 2021
Last NPPES UpdateJune 19, 2026
NPPES CertifiedJune 19, 2026
✔ NPI 1629656806 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPhysician AssistantPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363A00000X
Definition
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, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician.
1108 S 9TH ST, Grand Forks, ND 58201
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Other Names 1

Former Name (1)Madison Bakken

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Madison Lake's NPI number?

The NPI number for Madison Lake is 1629656806. It was assigned to this individual provider in the NPPES registry on March 30, 2021. The provider is also known as Madison Bakken.

Where is Madison Lake located?

Madison Lake practices at 1108 S 9th St, Grand Forks, ND 58201. The listed phone number is (218) 689-9517.

What is Madison Lake's specialty?

The primary specialty registered for this NPI is Physician Assistant with taxonomy code 363A00000X.

When was this NPI record last updated?

The NPPES record for Madison Lake was last updated on June 19, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 48 days ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.