MEDICARE: MARGO M PFUNDER CNM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	367A00000X	Advanced Practice Midwife	1096	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	1096	OTHER	CA	NURSE MIDWIFE CERTIFICATE

General Provider Information

NPI Number	:	1255415626
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARGO M PFUNDER CNM

Provider Business Mailing Address
First Line	:	PO BOX 60000
Second Line	:	FILE 73679
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94160-0001
Country	:	US
Telephone Number	:	707-464-8511
Fax Number	:

Provider Business Practice Location Address
First Line	:	780 E WASHINGTON BLVD
Second Line	:	SUITE 202
City	:	CRESCENT CITY
State	:	CA
Zip	:	95531-8397
Country	:	US
Telephone Number	:	707-464-6175
Fax Number	:	707-465-0870

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/24/2006
Last Update Date	:	03/07/2023

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