Healthcare Provider Details

I. General information

NPI: 1902153133
Provider Name (Legal Business Name): CAITLIN H MADISON CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CAITLIN ELIZABETH HANRAHAN

II. Dates (important events)

Enumeration Date: 08/07/2012
Last Update Date: 07/07/2021
Certification Date: 07/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 EUCLID AVE STE 30
SAN DIEGO CA
92114-3617
US

IV. Provider business mailing address

220 EUCLID AVE STE 30
SAN DIEGO CA
92114-3617
US

V. Phone/Fax

Practice location:
  • Phone: 888-874-3752
  • Fax:
Mailing address:
  • Phone: 888-874-3752
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberMW010283
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberMW010283
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License NumberNMW236145
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: