Provider Demographics
NPI:1639174329
Name:MADDEN, PAMELA M (CNM)
Entity Type:Individual
Prefix:MRS
First Name:PAMELA
Middle Name:M
Last Name:MADDEN
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9000 N MAIN ST
Mailing Address - Street 2:SUITE 234
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45415-1180
Mailing Address - Country:US
Mailing Address - Phone:937-277-8988
Mailing Address - Fax:937-832-2421
Practice Address - Street 1:9000 N MAIN ST
Practice Address - Street 2:SUITE 234
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45415-1180
Practice Address - Country:US
Practice Address - Phone:937-277-8988
Practice Address - Fax:937-832-2421
Is Sole Proprietor?:No
Enumeration Date:2005-06-17
Last Update Date:2015-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN185740/NM05283367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2191695Medicaid
OHP06347Medicare UPIN
OHP06347Medicare UPIN