Individual
DANIEL D MEDLOCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
APNP
Contact information
Practice address
1320 WISCONSIN AVE, RACINE, WI 53403-1978
(262) 687-2956
(262) 687-2014
Mailing address
1320 WISCONSIN AVE, RACINE, WI 53403-1978
(262) 687-2956
(262) 687-2014
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
9750
WI
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
9750
WI
Other
Enumeration date
05/25/2012
Last updated
01/24/2022
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