Healthcare Provider Details

I. General information

NPI: 1679384796
Provider Name (Legal Business Name): MADIGAN RENE NORTHRUP CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MADIGAN RENE GROFF

II. Dates (important events)

Enumeration Date: 01/17/2025
Last Update Date: 01/17/2025
Certification Date: 01/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 LATTIMORE RD STE 270
ROCHESTER NY
14620-4155
US

IV. Provider business mailing address

125 LATTIMORE RD STE 270
ROCHESTER NY
14620-4155
US

V. Phone/Fax

Practice location:
  • Phone: 585-275-7892
  • Fax: 585-442-6798
Mailing address:
  • Phone: 585-275-7892
  • Fax: 585-442-6798

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number002372
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: