Healthcare Provider Details

I. General information

NPI: 1952236069
Provider Name (Legal Business Name): MADELYN WINNIE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/17/2026
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 FULTON ST E
GRAND RAPIDS MI
49503-5917
US

IV. Provider business mailing address

500 FULTON ST E APT 353
GRAND RAPIDS MI
49503-4468
US

V. Phone/Fax

Practice location:
  • Phone: 616-315-4605
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: