Provider Demographics
NPI:1265740658
Name:URIAS, MADONNA FAYE
Entity type:Individual
Prefix:
First Name:MADONNA
Middle Name:FAYE
Last Name:URIAS
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 1:3704 AFTONSHIRE DR
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45430-1600
Mailing Address - Country:US
Mailing Address - Phone:937-475-1420
Mailing Address - Fax:
Practice Address - Street 1:3704 AFTONSHIRE DR
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45430-1600
Practice Address - Country:US
Practice Address - Phone:937-475-1420
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-20
Last Update Date:2010-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN.086695164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse