Provider Demographics
NPI:1336609064
Name:MADUMA, DANIEL OPIYO (DNP)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:OPIYO
Last Name:MADUMA
Suffix:
Gender:M
Credentials:DNP
Other - Prefix:
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Other - Middle Name:
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Mailing Address - Street 1:13395 N MARANA MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MARANA
Mailing Address - State:AZ
Mailing Address - Zip Code:85653-7008
Mailing Address - Country:US
Mailing Address - Phone:520-682-4111
Mailing Address - Fax:520-818-3630
Practice Address - Street 1:13395 N MARANA MAIN ST
Practice Address - Street 2:
Practice Address - City:MARANA
Practice Address - State:AZ
Practice Address - Zip Code:85653-7008
Practice Address - Country:US
Practice Address - Phone:520-682-4111
Practice Address - Fax:520-682-3817
Is Sole Proprietor?:No
Enumeration Date:2019-03-20
Last Update Date:2021-05-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ223756363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ513925Medicaid