Provider Demographics
NPI:1174741292
Name:MELO, MADELEINE C (RN, CNM)
Entity type:Individual
Prefix:
First Name:MADELEINE
Middle Name:C
Last Name:MELO
Suffix:
Gender:F
Credentials:RN, CNM
Other - Prefix:
Other - First Name:MADELEINE
Other - Middle Name:C
Other - Last Name:PUTNAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:120 JEWETT ST
Mailing Address - Street 2:
Mailing Address - City:FORT BRAGG
Mailing Address - State:CA
Mailing Address - Zip Code:95437-4510
Mailing Address - Country:US
Mailing Address - Phone:707-964-0676
Mailing Address - Fax:
Practice Address - Street 1:5176 HILL RD E
Practice Address - Street 2:
Practice Address - City:LAKEPORT
Practice Address - State:CA
Practice Address - Zip Code:95453-6300
Practice Address - Country:US
Practice Address - Phone:707-262-5088
Practice Address - Fax:707-263-3111
Is Sole Proprietor?:No
Enumeration Date:2007-04-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA23367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife