Healthcare Provider Details

I. General information

NPI: 1225009558
Provider Name (Legal Business Name): TONI JEANNE MADRID LM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JEANNE MADRID LM

II. Dates (important events)

Enumeration Date: 01/26/2006
Last Update Date: 12/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

930 BRYAN CIR
MOUNDS OK
74047-5392
US

IV. Provider business mailing address

930 BRYAN CIR
MOUNDS OK
74047-5392
US

V. Phone/Fax

Practice location:
  • Phone: 918-366-0301
  • Fax: 918-366-0301
Mailing address:
  • Phone: 918-366-0301
  • Fax: 918-366-0301

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License NumberMW22
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: