Healthcare Provider Details

I. General information

NPI: 1386939395
Provider Name (Legal Business Name): RUHEENA MADHURA NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2011
Last Update Date: 02/28/2023
Certification Date: 02/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1815 E LAKE MEAD BLVD STE 215
NORTH LAS VEGAS NV
89030-7190
US

IV. Provider business mailing address

1815 E LAKE MEAD BLVD STE 215
NORTH LAS VEGAS NV
89030-7190
US

V. Phone/Fax

Practice location:
  • Phone: 702-818-1919
  • Fax: 702-399-5499
Mailing address:
  • Phone: 702-818-1919
  • Fax: 702-399-5499

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN001809
License Number StateNV
# 2
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberAPRN001809
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: