Provider Demographics
NPI:1255415626
Name:PFUNDER, MARGO M (CNM)
Entity type:Individual
Prefix:
First Name:MARGO
Middle Name:M
Last Name:PFUNDER
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:PO BOX 60000
Mailing Address - Street 2:FILE 73679
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94160-0001
Mailing Address - Country:US
Mailing Address - Phone:707-464-8511
Mailing Address - Fax:
Practice Address - Street 1:780 E WASHINGTON BLVD
Practice Address - Street 2:SUITE 202
Practice Address - City:CRESCENT CITY
Practice Address - State:CA
Practice Address - Zip Code:95531-8397
Practice Address - Country:US
Practice Address - Phone:707-464-6175
Practice Address - Fax:707-465-0870
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA1096367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
CANMW010960Medicaid
CA1096OtherNURSE MIDWIFE CERTIFICATE
CAMP0899306OtherDEA