Provider Demographics
NPI:1740803634
Name:MADRONE CARE NETWORK, AN ADVANCED PRACTICE NURSING CORP
Entity Type:Organization
Organization Name:MADRONE CARE NETWORK, AN ADVANCED PRACTICE NURSING CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:NIAMH
Authorized Official - Middle Name:ISABEL
Authorized Official - Last Name:VAN MEINES
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:646-942-8148
Mailing Address - Street 1:117 BROOKLINE ST
Mailing Address - Street 2:
Mailing Address - City:MORAGA
Mailing Address - State:CA
Mailing Address - Zip Code:94556-1016
Mailing Address - Country:US
Mailing Address - Phone:646-942-8148
Mailing Address - Fax:925-888-2750
Practice Address - Street 1:117 BROOKLINE ST
Practice Address - Street 2:
Practice Address - City:MORAGA
Practice Address - State:CA
Practice Address - Zip Code:94556-1016
Practice Address - Country:US
Practice Address - Phone:646-942-8148
Practice Address - Fax:925-888-2750
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-26
Last Update Date:2020-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative MedicineGroup - Single Specialty