Provider Demographics
NPI:1487227047
Name:BACA, MADDISON (RN, CPM)
Entity Type:Individual
Prefix:
First Name:MADDISON
Middle Name:
Last Name:BACA
Suffix:
Gender:F
Credentials:RN, CPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3753 E WETHERSFIELD RD
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85032-7380
Mailing Address - Country:US
Mailing Address - Phone:602-616-5096
Mailing Address - Fax:
Practice Address - Street 1:8765 W KELTON LN UNIT B5E
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85382-3584
Practice Address - Country:US
Practice Address - Phone:602-616-5096
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-21
Last Update Date:2021-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife