Provider Demographics
NPI:1477874212
Name:MEDFORD, MARY CONSOLACION (RN, BSN, MA)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:CONSOLACION
Last Name:MEDFORD
Suffix:
Gender:F
Credentials:RN, BSN, MA
Other - Prefix:MISS
Other - First Name:MARY
Other - Middle Name:GRACE
Other - Last Name:CONSOLACION
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:8024 HILLANBY COURT
Mailing Address - Street 2:
Mailing Address - City:WATHAW
Mailing Address - State:NC
Mailing Address - Zip Code:28173-7699
Mailing Address - Country:US
Mailing Address - Phone:704-243-0303
Mailing Address - Fax:704-243-0299
Practice Address - Street 1:8024 HILLANBY COURT
Practice Address - Street 2:
Practice Address - City:WATHAW
Practice Address - State:NC
Practice Address - Zip Code:28173-7699
Practice Address - Country:US
Practice Address - Phone:704-243-0303
Practice Address - Fax:704-243-0299
Is Sole Proprietor?:No
Enumeration Date:2010-06-16
Last Update Date:2010-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC178109163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse