Provider Demographics
NPI:1073163655
Name:MADRUGA, CAROL ANN (RN451318)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:ANN
Last Name:MADRUGA
Suffix:
Gender:F
Credentials:RN451318
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1721 POPPY HILLS CT
Mailing Address - Street 2:
Mailing Address - City:MERCED
Mailing Address - State:CA
Mailing Address - Zip Code:95340-0761
Mailing Address - Country:US
Mailing Address - Phone:209-631-7441
Mailing Address - Fax:
Practice Address - Street 1:1721 POPPY HILLS CT
Practice Address - Street 2:
Practice Address - City:MERCED
Practice Address - State:CA
Practice Address - Zip Code:95340-0761
Practice Address - Country:US
Practice Address - Phone:209-631-7441
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-16
Last Update Date:2019-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARN451318163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant