Provider Demographics
NPI:1275003824
Name:MADU, EMEKA J (ACNP)
Entity type:Individual
Prefix:
First Name:EMEKA
Middle Name:J
Last Name:MADU
Suffix:
Gender:M
Credentials:ACNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:4275 BURNHAM AVE STE 220
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89119-5400
Mailing Address - Country:US
Mailing Address - Phone:702-796-4278
Mailing Address - Fax:702-737-9286
Practice Address - Street 1:4275 BURNHAM AVE STE 220
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89119-5400
Practice Address - Country:US
Practice Address - Phone:027-964-2787
Practice Address - Fax:702-737-9286
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-27
Last Update Date:2024-06-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA95025381363LA2100X
NVRN65666363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute CareGroup - Multi-Specialty