MEDICARE: RUHEENA MADHURA NP

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
1	363L00000X	Nurse Practitioner	APRN001809	NV
2	363LW0102X	Women's Health Nurse Practitioner	APRN001809	NV

General Provider Information

NPI Number	:	1386939395
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RUHEENA MADHURA NP

Provider Business Mailing Address
First Line	:	1815 E LAKE MEAD BLVD STE 215
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89030-7190
Country	:	US
Telephone Number	:	702-818-1919
Fax Number	:	702-399-5499

Provider Business Practice Location Address
First Line	:	1815 E LAKE MEAD BLVD STE 215
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89030-7190
Country	:	US
Telephone Number	:	702-818-1919
Fax Number	:	702-399-5499

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/17/2011
Last Update Date	:	02/28/2023

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