Provider Demographics
NPI:1790089175
Name:POWERS, MADELINE IRENE (CNM)
Entity Type:Individual
Prefix:MS
First Name:MADELINE
Middle Name:IRENE
Last Name:POWERS
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:MADELINE
Other - Middle Name:IRENE
Other - Last Name:POWERS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CNM
Mailing Address - Street 1:2929 E THOMAS RD
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85016-8034
Mailing Address - Country:US
Mailing Address - Phone:602-470-5000
Mailing Address - Fax:602-470-5064
Practice Address - Street 1:2525 E ROOSEVELT ST
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85008-4948
Practice Address - Country:US
Practice Address - Phone:602-344-5826
Practice Address - Fax:602-344-5596
Is Sole Proprietor?:No
Enumeration Date:2010-12-29
Last Update Date:2019-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ226020367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife