Provider Demographics
NPI:1568129922
Name:MADU, FIDELIA U
Entity Type:Individual
Prefix:
First Name:FIDELIA
Middle Name:U
Last Name:MADU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:455 ELIZABETH AVE APT 4I
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07112-2561
Mailing Address - Country:US
Mailing Address - Phone:862-452-6928
Mailing Address - Fax:
Practice Address - Street 1:455 ELIZABETH AVE APT 4I
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07112-2561
Practice Address - Country:US
Practice Address - Phone:862-452-6928
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-19
Last Update Date:2021-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ01233200363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily