MEDICARE: MRS. RACHEL MARLAINE MADRIGAL CLD

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	175M00000X	Lay Midwife

General Provider Information

NPI Number	:	1508119827
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. RACHEL MARLAINE MADRIGAL CLD

Provider Business Mailing Address
First Line	:	1947 CAPITAL DR
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80951-9754
Country	:	US
Telephone Number	:	719-287-0478
Fax Number	:

Provider Business Practice Location Address
First Line	:	1947 CAPITAL DR
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80951-9754
Country	:	US
Telephone Number	:	719-287-0478
Fax Number	:

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

Provider Enumeration Date	:	10/24/2012
Last Update Date	:	10/24/2012

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