Healthcare Provider Details

I. General information

NPI: 1851072573
Provider Name (Legal Business Name): KAONOULU P. MADELA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2023
Last Update Date: 07/26/2023
Certification Date: 07/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

891 HARBOR AVE
HENDERSON NV
89002-0974
US

IV. Provider business mailing address

891 HARBOR AVE
HENDERSON NV
89002-0974
US

V. Phone/Fax

Practice location:
  • Phone: 702-696-8423
  • Fax:
Mailing address:
  • Phone: 702-696-8423
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: