Basic Information
| Provider Information | |||||||||
| NPI: | 1275003824 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MADU | ||||||||
| FirstName: | EMEKA | ||||||||
| MiddleName: | J | ||||||||
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| Credential: | ACNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1470 E CALVADA BLVD STE 100 | ||||||||
| Address2: | |||||||||
| City: | PAHRUMP | ||||||||
| State: | NV | ||||||||
| PostalCode: | 890483906 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7752108333 | ||||||||
| FaxNumber: | 7753469158 | ||||||||
| Practice Location | |||||||||
| Address1: | 1460 E CALVADA BLVD | ||||||||
| Address2: | |||||||||
| City: | PAHRUMP | ||||||||
| State: | NV | ||||||||
| PostalCode: | 890485822 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7752108333 | ||||||||
| FaxNumber: | 7753469158 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/27/2018 | ||||||||
| LastUpdateDate: | 04/06/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 04/06/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LA2100X | 818780 | NV | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Acute Care | 363LA2100X | AP139836 | TX | N | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Acute Care |
No ID Information.