Individual
MS. DIANE M MEDINA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
R.N.
Contact information
Practice address
1664 19TH AVE, KENOSHA, WI 53140-1650
(262) 551-2826
(847) 937-7812
Mailing address
1664 19TH AVE, KENOSHA, WI 53140-1650
(262) 551-2826
(847) 937-7812
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
6534930
WI
Other
Enumeration date
10/11/2007
Last updated
10/11/2007
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