Provider Demographics
NPI:1912402611
Name:FERNANDEZ NODARSE, MADILEY
Entity Type:Individual
Prefix:
First Name:MADILEY
Middle Name:
Last Name:FERNANDEZ NODARSE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3612 MARKAM ST
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89121-2922
Mailing Address - Country:US
Mailing Address - Phone:702-523-2095
Mailing Address - Fax:
Practice Address - Street 1:3612 MARKAM ST
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89121-2922
Practice Address - Country:US
Practice Address - Phone:702-523-2095
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-26
Last Update Date:2022-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant