Provider Demographics
NPI:1669938064
Name:MADUKA, CHIMEZIE (RN)
Entity type:Individual
Prefix:
First Name:CHIMEZIE
Middle Name:
Last Name:MADUKA
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11441 ALLERTON PARK DR UNIT 218
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89135-3375
Mailing Address - Country:US
Mailing Address - Phone:702-574-0272
Mailing Address - Fax:
Practice Address - Street 1:7135 W SAHARA AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89117-2873
Practice Address - Country:US
Practice Address - Phone:702-227-5848
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-11
Last Update Date:2019-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVRN67143163WP2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP2201XNursing Service ProvidersRegistered NurseAmbulatory Care