Provider Demographics
NPI:1669519997
Name:TODEL, MADELENE SUSAN (CNM AND PA)
Entity type:Individual
Prefix:MS
First Name:MADELENE
Middle Name:SUSAN
Last Name:TODEL
Suffix:
Gender:F
Credentials:CNM AND PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2149 STUART ST # 1
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94705-1012
Mailing Address - Country:US
Mailing Address - Phone:510-548-5703
Mailing Address - Fax:
Practice Address - Street 1:KAISER PERMANENTE SANTA TERESA 250 HOSPITAL PARKWAY
Practice Address - Street 2:KAISER SANTA TERESA HOSPITAL
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95119
Practice Address - Country:US
Practice Address - Phone:408-972-6107
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACNM 1150367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife