Individual
MRS. MARY ELIZABETH MEDINA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN
Contact information
Practice address
691 SIERRA ROSE DR STE B, RENO, NV 89511-4010
(775) 453-1030
(775) 319-1613
Mailing address
13776 SWISS LANE, TRUCKEE CA, CA 96161-3416
(510) 367-5383
(510) 367-5383
Taxonomy
Speciality
Code
Description
License number
State
163WG0000X
General Practice Registered Nurse
450481
CA
363L00000X
Nurse Practitioner
Primary
826254
NV
363LF0000X
Family Nurse Practitioner
18684
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
14603059
CAQH
—
01
—
826254
NV APRN LIC
NV
Enumeration date
02/06/2009
Last updated
08/07/2025
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