Provider Demographics
NPI:1629173216
Name:MEDIN, NANETTE LYN (ANP)
Entity Type:Individual
Prefix:
First Name:NANETTE
Middle Name:LYN
Last Name:MEDIN
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2280 HARRISON AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:EUREKA
Mailing Address - State:CA
Mailing Address - Zip Code:95501-3200
Mailing Address - Country:US
Mailing Address - Phone:707-443-9371
Mailing Address - Fax:
Practice Address - Street 1:2280 HARRISON AVE
Practice Address - Street 2:SUITE B
Practice Address - City:EUREKA
Practice Address - State:CA
Practice Address - Zip Code:95501-3200
Practice Address - Country:US
Practice Address - Phone:707-443-9371
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2010-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP7883363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ16124ZMedicare PIN
S75166Medicare UPIN