Provider Demographics
NPI:1124662242
Name:MADAKIWE, STEMBILE
Entity type:Individual
Prefix:
First Name:STEMBILE
Middle Name:
Last Name:MADAKIWE
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 1:410 E PARKCENTER CIR N
Mailing Address - Street 2:
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92408-2869
Mailing Address - Country:US
Mailing Address - Phone:949-572-4873
Mailing Address - Fax:
Practice Address - Street 1:410 E PARKCENTER CIR N
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92408-2869
Practice Address - Country:US
Practice Address - Phone:949-572-4873
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-31
Last Update Date:2022-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95013154163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice