Provider Demographics
NPI:1487656112
Name:MEDINA-KREPPEIN, DAISY (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:DR
First Name:DAISY
Middle Name:
Last Name:MEDINA-KREPPEIN
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:DR
Other - First Name:DAISY
Other - Middle Name:
Other - Last Name:MEDINA-KREPPEIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DNP, FNP-BC
Mailing Address - Street 1:8315 98TH ST
Mailing Address - Street 2:APT 2C
Mailing Address - City:WOODHAVEN
Mailing Address - State:NY
Mailing Address - Zip Code:11421-1601
Mailing Address - Country:US
Mailing Address - Phone:718-850-5077
Mailing Address - Fax:
Practice Address - Street 1:2280 N OCEAN AVE
Practice Address - Street 2:INSIDE KMART
Practice Address - City:FARMINGVILLE
Practice Address - State:NY
Practice Address - Zip Code:11738-2911
Practice Address - Country:US
Practice Address - Phone:631-282-8450
Practice Address - Fax:631-320-1300
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-12
Last Update Date:2013-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY491154163W00000X
NY334130363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02827998Medicaid
NY02827998Medicaid