Healthcare Provider Details

I. General information

NPI: 1346946563
Provider Name (Legal Business Name): MADISON JOY CORNELL CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MADISON JOY CRUZ CNM

II. Dates (important events)

Enumeration Date: 01/31/2023
Last Update Date: 09/07/2026
Certification Date: 09/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2831 FORT MISSOULA RD
MISSOULA MT
59804-7419
US

IV. Provider business mailing address

1950 RIMEL RD APT 112
MISSOULA MT
59803-1549
US

V. Phone/Fax

Practice location:
  • Phone: 406-523-5650
  • Fax:
Mailing address:
  • Phone: 248-417-5412
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number002203
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: