Doctor Name: | MRS. SHEILA ANN MEDINA |
NPI Number: | 1619256518 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | NP |
License Number: | 0039513 |
Business Practice Address: | 1060 Gaffney Road #7410 Fort Wainwright, AK - 997037400 |
Business Phone Number: | 9073615603 |
Business Fax Number: | |
Mailing Address: | Po Box 35458, FORT WAINWRIGHT |
State: | AK |
Postal Code: | 997030458 |
Phone Number: | 2404767065 |
Fax Number: | |
NPI Enumeration Date: | 08/09/2011 |
NPI Last Update Date: | 08/09/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | 0039513 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | WI |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |