Provider Demographics
NPI:1215333927
Name:FANDEL, MADISON NICOLE (ND)
Entity type:Individual
Prefix:DR
First Name:MADISON
Middle Name:NICOLE
Last Name:FANDEL
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1305 PALMETTO AVE STE A
Mailing Address - Street 2:
Mailing Address - City:PACIFICA
Mailing Address - State:CA
Mailing Address - Zip Code:94044-2274
Mailing Address - Country:US
Mailing Address - Phone:650-501-9397
Mailing Address - Fax:855-952-2441
Practice Address - Street 1:1305 PALMETTO AVE STE A
Practice Address - Street 2:
Practice Address - City:PACIFICA
Practice Address - State:CA
Practice Address - Zip Code:94044-2274
Practice Address - Country:US
Practice Address - Phone:650-501-9397
Practice Address - Fax:855-952-2441
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-06
Last Update Date:2022-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WANT60518150175F00000X
CAND858175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath