Provider Demographics
NPI:1609002260
Name:MADDIN, MICHELLE LOUISE (RN)
Entity Type:Individual
Prefix:MISS
First Name:MICHELLE
Middle Name:LOUISE
Last Name:MADDIN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3230 PEACEKEEPER WAY
Mailing Address - Street 2:BLDG 209
Mailing Address - City:MCCLELLAN
Mailing Address - State:CA
Mailing Address - Zip Code:95652-2609
Mailing Address - Country:US
Mailing Address - Phone:916-830-1513
Mailing Address - Fax:916-929-1861
Practice Address - Street 1:3230 PEACEKEEPER WAY
Practice Address - Street 2:BLDG 209
Practice Address - City:MCCLELLAN
Practice Address - State:CA
Practice Address - Zip Code:95652-2609
Practice Address - Country:US
Practice Address - Phone:916-830-1513
Practice Address - Fax:916-929-1861
Is Sole Proprietor?:No
Enumeration Date:2009-06-09
Last Update Date:2009-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX689414163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management