Provider Demographics
NPI:1083018196
Name:MEDREK, KRISTEN (LPN)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:
Last Name:MEDREK
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8337 WRIGHT RD
Mailing Address - Street 2:
Mailing Address - City:HAMMONDSPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14840-9632
Mailing Address - Country:US
Mailing Address - Phone:607-794-7784
Mailing Address - Fax:
Practice Address - Street 1:8337 WRIGHT RD
Practice Address - Street 2:
Practice Address - City:HAMMONDSPORT
Practice Address - State:NY
Practice Address - Zip Code:14840-9632
Practice Address - Country:US
Practice Address - Phone:607-794-7784
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-17
Last Update Date:2014-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY308907-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse