Provider Demographics
NPI:1225479660
Name:MADANA, NIDHI KUMAR (RN, FNP)
Entity Type:Individual
Prefix:MRS
First Name:NIDHI
Middle Name:KUMAR
Last Name:MADANA
Suffix:
Gender:F
Credentials:RN, FNP
Other - Prefix:
Other - First Name:NIDHI
Other - Middle Name:BALA
Other - Last Name:KUMAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:26238 APPIAN WAY
Mailing Address - Street 2:
Mailing Address - City:LOMITA
Mailing Address - State:CA
Mailing Address - Zip Code:90717-3407
Mailing Address - Country:US
Mailing Address - Phone:510-384-3192
Mailing Address - Fax:
Practice Address - Street 1:3828 DELMAS TER
Practice Address - Street 2:
Practice Address - City:CULVER CITY
Practice Address - State:CA
Practice Address - Zip Code:90232-2713
Practice Address - Country:US
Practice Address - Phone:310-836-7000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-15
Last Update Date:2019-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA22561363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACB254379OtherPTAN