Provider Demographics
NPI:1740328848
Name:FINKELSTEIN, MADELYNN STACEY (RNP)
Entity type:Individual
Prefix:
First Name:MADELYNN
Middle Name:STACEY
Last Name:FINKELSTEIN
Suffix:
Gender:F
Credentials:RNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1320 GLENAVON AVE
Mailing Address - Street 2:
Mailing Address - City:VENICE
Mailing Address - State:CA
Mailing Address - Zip Code:90291-2910
Mailing Address - Country:US
Mailing Address - Phone:310-399-4029
Mailing Address - Fax:
Practice Address - Street 1:1711 OCEAN PARK BLVD
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90405-4901
Practice Address - Country:US
Practice Address - Phone:310-450-2191
Practice Address - Fax:310-450-0873
Is Sole Proprietor?:No
Enumeration Date:2007-02-01
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA6200363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA6200Medicaid