Provider Demographics
NPI:1295253102
Name:MEDRANO, MILDRED J (CRNP-FNP)
Entity type:Individual
Prefix:
First Name:MILDRED
Middle Name:J
Last Name:MEDRANO
Suffix:
Gender:F
Credentials:CRNP-FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9906 EDGEWATER TER
Mailing Address - Street 2:
Mailing Address - City:FORT WASHINGTON
Mailing Address - State:MD
Mailing Address - Zip Code:20744-5758
Mailing Address - Country:US
Mailing Address - Phone:573-408-0228
Mailing Address - Fax:
Practice Address - Street 1:9229 ARLINGTON ARLINGTON BLVD.
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22031
Practice Address - Country:US
Practice Address - Phone:573-408-0228
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-31
Last Update Date:2017-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024174865363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily