Provider Demographics
NPI:1003589326
Name:CARMONA, MADELYN SPRING PETERSON (CNM)
Entity Type:Individual
Prefix:
First Name:MADELYN
Middle Name:SPRING PETERSON
Last Name:CARMONA
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:MADELYN
Other - Middle Name:SPRING
Other - Last Name:PETERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:560 2ND ST
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:CA
Mailing Address - Zip Code:94801-2604
Mailing Address - Country:US
Mailing Address - Phone:503-407-1702
Mailing Address - Fax:
Practice Address - Street 1:2 H ST
Practice Address - Street 2:
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94901-1700
Practice Address - Country:US
Practice Address - Phone:925-887-5247
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-01
Last Update Date:2023-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA236215367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife