Provider Demographics
NPI:1093215030
Name:MADU, TANISHA (RN)
Entity Type:Individual
Prefix:MRS
First Name:TANISHA
Middle Name:
Last Name:MADU
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:902 MAZOURKA DR
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76001-6117
Mailing Address - Country:US
Mailing Address - Phone:817-679-1275
Mailing Address - Fax:
Practice Address - Street 1:902 MAZOURKA DR
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76001-6117
Practice Address - Country:US
Practice Address - Phone:817-679-1275
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-16
Last Update Date:2018-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX919912163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse