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General NPI Number Information
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NPI Number | 1225170541
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Entity Type | Individual
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Provider Name | PAMELA M. G. MADALA FNP
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Gender | Female
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Dates
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Enumeration Date | 02/13/2007
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Last Update Date | 06/04/2014
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Provider Practice Location Address
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Address Line | 11899 SHAW PL
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City | HANFORD
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State | CA
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Zip | 93230-6644
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Country | US
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Telephone | 559-585-3437
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Fax | 559-585-3444
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Provider Business Mailing Address
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Address Line | 1479 W LACEY BLVE
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City | HANFORD
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State | CA
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Zip | 93230
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Country | US
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Telephone | 559-583-4617
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Fax | 559-583-4625
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | NP 13589
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License Number State | CA
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