MEDICARE: MRS. STELLA NDIDI MADUKA FNP-C

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	363LF0000X	Family Nurse Practitioner	723609	TX

General Provider Information

NPI Number	:	1699031609
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. STELLA NDIDI MADUKA FNP-C

Provider Business Mailing Address
First Line	:	2018 RUSTIC OAK LN
Second Line	:
City	:	RICHMOND
State	:	TX
Zip	:	77469-5651
Country	:	US
Telephone Number	:	832-766-2270
Fax Number	:	281-232-7422

Provider Business Practice Location Address
First Line	:	2018 RUSTIC OAK LN
Second Line	:
City	:	RICHMOND
State	:	TX
Zip	:	77469-5651
Country	:	US
Telephone Number	:	832-766-2270
Fax Number	:	128-123-2742

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

Provider Enumeration Date	:	04/03/2012
Last Update Date	:	04/03/2012

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