Provider Demographics
NPI:1740202126
Name:BOURDEAU, RIFKA MADRONA (CPM, LM)
Entity Type:Individual
Prefix:MS
First Name:RIFKA
Middle Name:MADRONA
Last Name:BOURDEAU
Suffix:
Gender:F
Credentials:CPM, LM
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 1624
Mailing Address - Street 2:
Mailing Address - City:TAOS
Mailing Address - State:NM
Mailing Address - Zip Code:87571-1624
Mailing Address - Country:US
Mailing Address - Phone:575-779-7571
Mailing Address - Fax:
Practice Address - Street 1:318 PASEO DEL NORTE # 1624
Practice Address - Street 2:
Practice Address - City:TAOS
Practice Address - State:NM
Practice Address - Zip Code:87571-9066
Practice Address - Country:US
Practice Address - Phone:575-779-7571
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-24
Last Update Date:2014-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM09067R176B00000X
ORDEM-LD-707159176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR140157OtherOREGON PROVIDER #