Healthcare Provider Details

I. General information

NPI: 1497460679
Provider Name (Legal Business Name): CIARA NICHOLE MADRIGAL NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/23/2023
Last Update Date: 12/11/2024
Certification Date: 12/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

513 N EDISON ST
KENNEWICK WA
99336-2217
US

IV. Provider business mailing address

513 N EDISON ST
KENNEWICK WA
99336-2217
US

V. Phone/Fax

Practice location:
  • Phone: 509-537-3462
  • Fax:
Mailing address:
  • Phone: 509-537-3462
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP61406177
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: