Provider Demographics
NPI:1093994238
Name:MEDLEY, GINA E (LPN)
Entity Type:Individual
Prefix:MRS
First Name:GINA
Middle Name:E
Last Name:MEDLEY
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 1:18701 W THOMAS RD
Mailing Address - Street 2:
Mailing Address - City:LITCHFIELD PARK
Mailing Address - State:AZ
Mailing Address - Zip Code:85340-9324
Mailing Address - Country:US
Mailing Address - Phone:623-535-6200
Mailing Address - Fax:623-935-7803
Practice Address - Street 1:553 E PLAZA CIR DR
Practice Address - Street 2:
Practice Address - City:LITCHFIELD PARK
Practice Address - State:AZ
Practice Address - Zip Code:85340-4930
Practice Address - Country:US
Practice Address - Phone:623-535-6000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-24
Last Update Date:2007-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLP037280164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse