Provider Demographics
NPI:1225170541
Name:MADALA, PAMELA M G (FNP)
Entity Type:Individual
Prefix:MRS
First Name:PAMELA
Middle Name:M G
Last Name:MADALA
Suffix:
Gender:F
Credentials:FNP
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Mailing Address - Street 1:1479 W LACEY BLVE
Mailing Address - Street 2:
Mailing Address - City:HANFORD
Mailing Address - State:CA
Mailing Address - Zip Code:93230
Mailing Address - Country:US
Mailing Address - Phone:559-583-4617
Mailing Address - Fax:559-583-4625
Practice Address - Street 1:11899 SHAW PL
Practice Address - Street 2:
Practice Address - City:HANFORD
Practice Address - State:CA
Practice Address - Zip Code:93230-6644
Practice Address - Country:US
Practice Address - Phone:559-585-3437
Practice Address - Fax:559-585-3444
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-13
Last Update Date:2014-06-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CANP 13589363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner