Provider Demographics
NPI:1689454241
Name:MEDINA, ROSA MIRNA (RN)
Entity Type:Individual
Prefix:MRS
First Name:ROSA
Middle Name:MIRNA
Last Name:MEDINA
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16138 STUARTS DRAFT CT
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28278-7278
Mailing Address - Country:US
Mailing Address - Phone:980-200-4165
Mailing Address - Fax:
Practice Address - Street 1:1000 WELLNESS WAY
Practice Address - Street 2:
Practice Address - City:FORT MILL
Practice Address - State:SC
Practice Address - Zip Code:29715-7315
Practice Address - Country:US
Practice Address - Phone:803-835-7700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-02
Last Update Date:2023-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC331759163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse