Provider Demographics
NPI:1881024487
Name:MADAYAG, FERDINAND RAYCO (APRN)
Entity type:Individual
Prefix:MR
First Name:FERDINAND
Middle Name:RAYCO
Last Name:MADAYAG
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
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Mailing Address - Street 1:3325 RESEARCH WAY
Mailing Address - Street 2:
Mailing Address - City:CARSON CITY
Mailing Address - State:NV
Mailing Address - Zip Code:89706-7913
Mailing Address - Country:US
Mailing Address - Phone:775-888-6610
Mailing Address - Fax:775-888-4904
Practice Address - Street 1:845 E FARM RD
Practice Address - Street 2:HCR 69, BOX 401-V
Practice Address - City:AMARGOSA VALLEY
Practice Address - State:NV
Practice Address - Zip Code:89020-9795
Practice Address - Country:US
Practice Address - Phone:775-372-5432
Practice Address - Fax:775-372-1303
Is Sole Proprietor?:No
Enumeration Date:2013-11-18
Last Update Date:2017-03-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NVAPRN001614363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1881024487Medicaid
NVPENDINGMedicare PIN