Provider Demographics
NPI:1528587938
Name:MEDINA-QUEZADA, BETHANY
Entity Type:Individual
Prefix:
First Name:BETHANY
Middle Name:
Last Name:MEDINA-QUEZADA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:BETHANY
Other - Middle Name:
Other - Last Name:MEDINA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4095 AMERICAN WAY STE 1
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38118-8339
Mailing Address - Country:US
Mailing Address - Phone:901-271-9500
Mailing Address - Fax:865-342-0120
Practice Address - Street 1:4095 AMERICAN WAY STE 1
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38118-8339
Practice Address - Country:US
Practice Address - Phone:901-271-9500
Practice Address - Fax:865-342-0120
Is Sole Proprietor?:No
Enumeration Date:2017-09-18
Last Update Date:2017-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide