Healthcare Provider Details

I. General information

NPI: 1508823915
Provider Name (Legal Business Name): PATRICIA ANN MADDEN CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/28/2006
Last Update Date: 07/03/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1575 HIGHLANDS DR SUITE 101
LITITZ PA
17543-7507
US

IV. Provider business mailing address

409 SOUTH SECOND STREET SUITE 2F
HARRISBURG PA
17104-1612
US

V. Phone/Fax

Practice location:
  • Phone: 888-393-1338
  • Fax: 717-627-1817
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberMW008533L
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier1029020600001
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer
# 2
Identifier0080314
Identifier TypeMEDICAID
Identifier StateNJ
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: