Provider Demographics
NPI:1255734646
Name:ZEGERS, MADELON
Entity type:Individual
Prefix:
First Name:MADELON
Middle Name:
Last Name:ZEGERS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3814 AUBURN BLVD
Mailing Address - Street 2:SUITE 72
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95821-2123
Mailing Address - Country:US
Mailing Address - Phone:916-426-1902
Mailing Address - Fax:916-426-1940
Practice Address - Street 1:3814 AUBURN BLVD
Practice Address - Street 2:SUITE 72
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95821-2123
Practice Address - Country:US
Practice Address - Phone:916-426-1902
Practice Address - Fax:916-426-1940
Is Sole Proprietor?:No
Enumeration Date:2014-09-30
Last Update Date:2014-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA415027363LP0200X
CA5766363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics