Provider Demographics
NPI:1740521913
Name:MALDONADO, MARKIE DANIELLE (PA-C)
Entity type:Individual
Prefix:
First Name:MARKIE
Middle Name:DANIELLE
Last Name:MALDONADO
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:255 W COURT ST
Mailing Address - Street 2:STE D
Mailing Address - City:WOODLAND
Mailing Address - State:CA
Mailing Address - Zip Code:95695-2986
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:255 W COURT ST
Practice Address - Street 2:STE D
Practice Address - City:WOODLAND
Practice Address - State:CA
Practice Address - Zip Code:95695-2986
Practice Address - Country:US
Practice Address - Phone:530-406-7993
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-12
Last Update Date:2017-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA53968363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant