Provider Demographics
NPI:1407496326
Name:MEDFORD, MYRNA R
Entity Type:Individual
Prefix:
First Name:MYRNA
Middle Name:R
Last Name:MEDFORD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MYRNA
Other - Middle Name:RAE
Other - Last Name:BROWNRIGG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2850 N COUNTRY CLUB RD
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85716-1910
Mailing Address - Country:US
Mailing Address - Phone:203-226-2745
Mailing Address - Fax:520-509-4496
Practice Address - Street 1:2428 W REYNOLDS AVE
Practice Address - Street 2:
Practice Address - City:CENTRALIA
Practice Address - State:WA
Practice Address - Zip Code:98531-4554
Practice Address - Country:US
Practice Address - Phone:360-330-9044
Practice Address - Fax:360-736-3139
Is Sole Proprietor?:No
Enumeration Date:2020-01-08
Last Update Date:2022-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ0123456789376J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker