Healthcare Provider Details

I. General information

NPI: 1316661770
Provider Name (Legal Business Name): MADELINE CUSHING RAQUE CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MADELINE CUSHING

II. Dates (important events)

Enumeration Date: 09/29/2022
Last Update Date: 01/02/2026
Certification Date: 01/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 BON AIR RD
GREENBRAE CA
94904-1702
US

IV. Provider business mailing address

599 SIR FRANCIS DRAKE BLVD STE 301
GREENBRAE CA
94904-1732
US

V. Phone/Fax

Practice location:
  • Phone: 415-925-7591
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number236323
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: