Provider Demographics
NPI:1346632908
Name:HANSA B. MEDLEY M.D.
Entity Type:Organization
Organization Name:HANSA B. MEDLEY M.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FAMILY NURSE PRACTITIONER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CARRETTA
Authorized Official - Middle Name:L
Authorized Official - Last Name:MWESIGA
Authorized Official - Suffix:
Authorized Official - Credentials:MSN, FNP-C
Authorized Official - Phone:713-782-2156
Mailing Address - Street 1:3920 BRAXTON DR STE 108
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77063-6304
Mailing Address - Country:US
Mailing Address - Phone:713-782-2156
Mailing Address - Fax:713-782-5054
Practice Address - Street 1:3920 BRAXTON DR STE 108
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77063-6304
Practice Address - Country:US
Practice Address - Phone:713-782-2156
Practice Address - Fax:713-782-5054
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-19
Last Update Date:2015-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP127227261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care