Provider Demographics
NPI:1437499159
Name:MEDINA, NORMA (NP)
Entity Type:Individual
Prefix:
First Name:NORMA
Middle Name:
Last Name:MEDINA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:NORMA
Other - Middle Name:MEDINA
Other - Last Name:NAVARRO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:10 WOODLAND RD
Mailing Address - Street 2:
Mailing Address - City:SAINT HELENA
Mailing Address - State:CA
Mailing Address - Zip Code:94574-9554
Mailing Address - Country:US
Mailing Address - Phone:707-967-5721
Mailing Address - Fax:707-967-5722
Practice Address - Street 1:10 WOODLAND RD
Practice Address - Street 2:
Practice Address - City:SAINT HELENA
Practice Address - State:CA
Practice Address - Zip Code:94574
Practice Address - Country:US
Practice Address - Phone:707-967-5721
Practice Address - Fax:707-967-5722
Is Sole Proprietor?:No
Enumeration Date:2013-02-15
Last Update Date:2018-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA710198363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner