Provider Demographics
NPI:1639893605
Name:MEDLEY, NICOLA
Entity Type:Individual
Prefix:
First Name:NICOLA
Middle Name:
Last Name:MEDLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 92
Mailing Address - Street 2:
Mailing Address - City:STEVENSON
Mailing Address - State:CT
Mailing Address - Zip Code:06491-0092
Mailing Address - Country:US
Mailing Address - Phone:203-843-8779
Mailing Address - Fax:203-268-5289
Practice Address - Street 1:371 WEBB CIR
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:CT
Practice Address - Zip Code:06468-1426
Practice Address - Country:US
Practice Address - Phone:203-843-8779
Practice Address - Fax:203-268-5289
Is Sole Proprietor?:No
Enumeration Date:2022-10-03
Last Update Date:2022-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTHCA.0001629376J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker