Individual
STEPHANIE LYN MEDINA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2349 N 83RD DR, PHOENIX, AZ 85037-3742
(619) 309-6824
Mailing address
2349 N 83RD DR, PHOENIX, AZ 85037-3742
(619) 309-6824
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
218387
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
218387
LICENCED PRACTICAL NURSE
AZ
Enumeration date
10/13/2020
Last updated
10/13/2020
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