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NPI Code Detail

MEDICARE: MR. IFEANYI C MADU NURSE PRACTITIONER

MEDICARE: MR. IFEANYI C MADU NURSE PRACTITIONER
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LG0600XGerontology Nurse Practitioner818778NV
2363LF0000XFamily Nurse Practitioner818778NV

General Provider Information

NPI Number : 1295295038
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. IFEANYI C MADU NURSE PRACTITIONER
Provider Business Mailing Address
First Line : 6101 BLUE LAGOON DR STE 200
Second Line :
City : MIAMI
State : FL
Zip : 33126-3168
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 390 W LAKE MEAD PKWY STE 120
Second Line :
City : HENDERSON
State : NV
Zip : 89015-7417
Country : US
Telephone Number : 725-220-8477
Fax Number : 833-749-0360
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/20/2019
Last Update Date : 02/19/2026

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