Individual
HEIDI L MEDINA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APNP NP
Contact information
Practice address
803 W LAYTON AVE, MILWAUKEE, WI 53221-2426
(414) 939-4411
Mailing address
803 W LAYTON AVE, MILWAUKEE, WI 53221-2426
(414) 939-4411
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
8575
WI
363LF0000X
Family Nurse Practitioner
8573-33
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100084231
—
WI
Enumeration date
09/28/2018
Last updated
06/28/2022
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