Provider Demographics
NPI:1710013024
Name:BADUM, MARIELA (RN, BSN)
Entity Type:Individual
Prefix:
First Name:MARIELA
Middle Name:
Last Name:BADUM
Suffix:
Gender:F
Credentials:RN, BSN
Other - Prefix:
Other - First Name:MARIELA
Other - Middle Name:
Other - Last Name:BADUM
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHN
Mailing Address - Street 1:327 COLLEGE AVE.
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95401-5117
Mailing Address - Country:US
Mailing Address - Phone:707-568-2800
Mailing Address - Fax:707-568-2804
Practice Address - Street 1:327 COLLEGE AVE.
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95401-5117
Practice Address - Country:US
Practice Address - Phone:707-568-2800
Practice Address - Fax:707-568-2804
Is Sole Proprietor?:No
Enumeration Date:2007-02-23
Last Update Date:2008-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALVN216445164X00000X
CA723539163W00000X
CA73297163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No164X00000XNursing Service ProvidersLicensed Vocational Nurse
No163WC1500XNursing Service ProvidersRegistered NurseCommunity Health