Provider Demographics
NPI:1437813938
Name:MEDLEN, THOMAS (RN)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:
Last Name:MEDLEN
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:TOM
Other - Middle Name:
Other - Last Name:MEDLEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:915 CABERNET CT
Mailing Address - Street 2:
Mailing Address - City:OAKLEY
Mailing Address - State:CA
Mailing Address - Zip Code:94561-2300
Mailing Address - Country:US
Mailing Address - Phone:925-395-6278
Mailing Address - Fax:
Practice Address - Street 1:915 CABERNET CT
Practice Address - Street 2:
Practice Address - City:OAKLEY
Practice Address - State:CA
Practice Address - Zip Code:94561-2300
Practice Address - Country:US
Practice Address - Phone:925-395-6278
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-29
Last Update Date:2021-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95232386163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse