Provider Demographics
NPI:1912251687
Name:NDULAKA, ADA N (FNP-BC)
Entity Type:Individual
Prefix:
First Name:ADA
Middle Name:N
Last Name:NDULAKA
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:ADA
Other - Middle Name:N
Other - Last Name:EMENUGA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP-BC
Mailing Address - Street 1:PO BOX 98978
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89193-8978
Mailing Address - Country:US
Mailing Address - Phone:702-216-3346
Mailing Address - Fax:702-671-6883
Practice Address - Street 1:4275 BURNHAM AVE
Practice Address - Street 2:#255
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89119-5488
Practice Address - Country:US
Practice Address - Phone:702-369-0088
Practice Address - Fax:702-893-4913
Is Sole Proprietor?:No
Enumeration Date:2012-11-02
Last Update Date:2020-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVAPRN001798363LP0808X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1912251687Medicaid
NV1912251687Medicaid
NVV109027Medicare PIN