Provider Demographics
NPI:1154388411
Name:MADRONE, ALISHA VILA (CNM, MN)
Entity type:Individual
Prefix:
First Name:ALISHA
Middle Name:VILA
Last Name:MADRONE
Suffix:
Gender:F
Credentials:CNM, MN
Other - Prefix:MS
Other - First Name:ALISHA
Other - Middle Name:DEANNE
Other - Last Name:VILA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNM, MN
Mailing Address - Street 1:2024 SE CLINTON ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97202-2245
Mailing Address - Country:US
Mailing Address - Phone:503-238-6262
Mailing Address - Fax:503-200-1229
Practice Address - Street 1:2024 SE CLINTON ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97202-2245
Practice Address - Country:US
Practice Address - Phone:503-238-6262
Practice Address - Fax:503-200-1229
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-28
Last Update Date:2010-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR200450053NP NMNP367A00000X
OR200450053NP NMNP-PP367A00000X
OR200141810RN163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No163W00000XNursing Service ProvidersRegistered Nurse