Provider Demographics
NPI:1306217534
Name:THIRUMALAI, ANURADHA (FNP-BC)
Entity Type:Individual
Prefix:MS
First Name:ANURADHA
Middle Name:
Last Name:THIRUMALAI
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:268 LAZY POSEY CT
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89106-3982
Mailing Address - Country:US
Mailing Address - Phone:702-671-4103
Mailing Address - Fax:
Practice Address - Street 1:3230 S BUFFALO DR STE 104
Practice Address - Street 2:INTEGRATED MEDICAL GROUP
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89117-2506
Practice Address - Country:US
Practice Address - Phone:702-997-5588
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-14
Last Update Date:2015-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVAPRN002029363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily