Provider Demographics
NPI:1679384796
Name:NORTHRUP, MADIGAN RENE (CNM)
Entity type:Individual
Prefix:
First Name:MADIGAN
Middle Name:RENE
Last Name:NORTHRUP
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:MADIGAN
Other - Middle Name:RENE
Other - Last Name:GROFF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:125 LATTIMORE RD STE 270
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14620-4155
Mailing Address - Country:US
Mailing Address - Phone:585-275-7892
Mailing Address - Fax:585-442-6798
Practice Address - Street 1:125 LATTIMORE RD STE 270
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14620-4155
Practice Address - Country:US
Practice Address - Phone:585-275-7892
Practice Address - Fax:585-442-6798
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-17
Last Update Date:2025-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002372367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife