Individual
ELISE MARIE MEDINA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3500 CIVIC CENTER BLVD, PHILADELPHIA, PA 19104-4395
(215) 590-1000
Mailing address
3401 CIVIC CENTER BLVD, PHILADELPHIA, PA 19104-4319
(215) 590-1000
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
SP026366
PA
Other
Enumeration date
11/04/2022
Last updated
11/04/2022
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