Provider Demographics
NPI:1538651104
Name:MADDOX, SPRING GENNAY (CNM, WHNP)
Entity Type:Individual
Prefix:
First Name:SPRING
Middle Name:GENNAY
Last Name:MADDOX
Suffix:
Gender:F
Credentials:CNM, WHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 897
Mailing Address - Street 2:
Mailing Address - City:TUOLUMNE
Mailing Address - State:CA
Mailing Address - Zip Code:95379-0897
Mailing Address - Country:US
Mailing Address - Phone:209-928-4907
Mailing Address - Fax:
Practice Address - Street 1:18400 CHESTNUT AVE
Practice Address - Street 2:
Practice Address - City:TUOLUMNE
Practice Address - State:CA
Practice Address - Zip Code:95379
Practice Address - Country:US
Practice Address - Phone:209-928-4907
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-31
Last Update Date:2018-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife