Provider Demographics
NPI:1902453996
Name:RUBINICH, MADOLYN ISABELLE (CNM)
Entity Type:Individual
Prefix:
First Name:MADOLYN
Middle Name:ISABELLE
Last Name:RUBINICH
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11102 SUNRISE BLVD E STE 110
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98374-8846
Mailing Address - Country:US
Mailing Address - Phone:253-697-3550
Mailing Address - Fax:
Practice Address - Street 1:11102 SUNRISE BLVD E STE 110
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98374-8846
Practice Address - Country:US
Practice Address - Phone:253-697-3550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-23
Last Update Date:2022-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN60975480163W00000X
WAAP61342292363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse