Individual
EDITH DIANE MEDLEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
NURSE PRACTITIONER
Contact information
Practice address
5103 TANGLEWOOD CT, NA, SUFFOLK, VA 23435-2637
(757) 638-1320
(757) 638-1039
Mailing address
5103 TANGLEWOOD CT, NA, SUFFOLK, VA 23435-2637
(757) 638-1320
(757) 638-1039
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
0024093905
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0001093905
REGISTERED NURSE
VA
01
—
0017000287
AUTHORIZATION TO PRESCRI
VA
01
—
0024093905
NURSE PRACTITIONER
VA
Enumeration date
07/23/2007
Last updated
03/07/2023
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