Healthcare Provider Details

I. General information

NPI: 1578479028
Provider Name (Legal Business Name): MADALYN WACHTER CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MADALYN BADEN

II. Dates (important events)

Enumeration Date: 08/24/2026
Last Update Date: 08/24/2026
Certification Date: 08/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 LAGOON AVE
MINNEAPOLIS MN
55408-2077
US

IV. Provider business mailing address

1200 LAGOON AVE
MINNEAPOLIS MN
55408-2077
US

V. Phone/Fax

Practice location:
  • Phone: 651-696-5671
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number680
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: