Provider Demographics
NPI:1457048530
Name:MADDEN, TRUDY MICHELLE (LVN)
Entity Type:Individual
Prefix:
First Name:TRUDY
Middle Name:MICHELLE
Last Name:MADDEN
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1404 ASH ST
Mailing Address - Street 2:
Mailing Address - City:RAMONA
Mailing Address - State:CA
Mailing Address - Zip Code:92065-1316
Mailing Address - Country:US
Mailing Address - Phone:619-288-6701
Mailing Address - Fax:760-896-6928
Practice Address - Street 1:1404 ASH ST
Practice Address - Street 2:
Practice Address - City:RAMONA
Practice Address - State:CA
Practice Address - Zip Code:92065-1316
Practice Address - Country:US
Practice Address - Phone:619-288-6701
Practice Address - Fax:760-896-6928
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-19
Last Update Date:2023-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN182714164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse