Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 176B00000X | Midwife |
NPI | 1134333818 |
---|---|
Provider Name | Mrs. Tracy Page Madler |
First Address | Prescott Valley, AZ 86314 |
Second Address | Prescott, AZ 86301 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/05/2007 |
Last Update Date | 08/07/2007 |