Provider Demographics
NPI:1710291323
Name:MEDINA, DOROTHY ANNE (ACNP)
Entity Type:Individual
Prefix:
First Name:DOROTHY
Middle Name:ANNE
Last Name:MEDINA
Suffix:
Gender:F
Credentials:ACNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:38935 ANN ARBOR RD
Mailing Address - Street 2:CREDENTIALING DEPT
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48150-3397
Mailing Address - Country:US
Mailing Address - Phone:734-805-0488
Mailing Address - Fax:866-250-6385
Practice Address - Street 1:8260 ATLEE RD
Practice Address - Street 2:EMERGENCY DEPT
Practice Address - City:MECHANICSVILLE
Practice Address - State:VA
Practice Address - Zip Code:23116-1844
Practice Address - Country:US
Practice Address - Phone:804-764-6300
Practice Address - Fax:804-764-6562
Is Sole Proprietor?:No
Enumeration Date:2010-08-06
Last Update Date:2014-01-10
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Provider Licenses
StateLicense IDTaxonomies
VA0024168889363LA2100X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner