Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | NP95017392 | CA |
NPI | 1023685021 |
---|---|
Provider Name | Mrs. Harrieth Amaka Madu |
First Address | Carson, CA 90746-1524 |
Second Address | Los Angeles, CA 90059-3052 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/06/2021 |
Last Update Date | 08/06/2021 |