Provider Demographics
NPI:1134874415
Name:SCHAEFER, MADISON JANE (MS)
Entity type:Individual
Prefix:
First Name:MADISON
Middle Name:JANE
Last Name:SCHAEFER
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:MADISON
Other - Middle Name:JANE
Other - Last Name:DARNALL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1932 PELORUS AVE
Mailing Address - Street 2:
Mailing Address - City:SEAL BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90740-5768
Mailing Address - Country:US
Mailing Address - Phone:206-819-0116
Mailing Address - Fax:
Practice Address - Street 1:1932 PELORUS AVE
Practice Address - Street 2:
Practice Address - City:SEAL BEACH
Practice Address - State:CA
Practice Address - Zip Code:90740-5768
Practice Address - Country:US
Practice Address - Phone:206-819-0116
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-15
Last Update Date:2022-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist