Provider Demographics
NPI:1962166330
Name:ZEA, MADELINE JEAN (PA)
Entity type:Individual
Prefix:
First Name:MADELINE
Middle Name:JEAN
Last Name:ZEA
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17968 GAMBLE LN
Mailing Address - Street 2:
Mailing Address - City:GRASS VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:95949-6908
Mailing Address - Country:US
Mailing Address - Phone:530-559-7739
Mailing Address - Fax:
Practice Address - Street 1:17968 GAMBLE LN
Practice Address - Street 2:
Practice Address - City:GRASS VALLEY
Practice Address - State:CA
Practice Address - Zip Code:95949-6908
Practice Address - Country:US
Practice Address - Phone:530-559-7739
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-22
Last Update Date:2022-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE114977207PE0004X
CA60405363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services