Provider Demographics
NPI:1790394591
Name:ANDERSON, MADELINE CAROL (CNM)
Entity Type:Individual
Prefix:
First Name:MADELINE
Middle Name:CAROL
Last Name:ANDERSON
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 1:2025 P ST
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95811-5213
Mailing Address - Country:US
Mailing Address - Phone:916-936-2229
Mailing Address - Fax:
Practice Address - Street 1:2025 P ST
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95811-5213
Practice Address - Country:US
Practice Address - Phone:916-936-2229
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-28
Last Update Date:2020-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CNM06163367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife