Individual
TIA C MEDLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
9000 W WISCONSIN AVE, MILWAUKEE, WI 53226-4874
(414) 266-2860
(414) 266-6749
Mailing address
9000 W WISCONSIN AVE, MILWAUKEE, WI 53226-4874
(414) 266-2860
(414) 266-6749
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
4243-33
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1609182161
—
WI
Enumeration date
08/23/2010
Last updated
01/28/2022
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