Provider Demographics
NPI:1356972178
Name:MEDINA, KAREN (ADVANCED PRACTICE NU)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:
Last Name:MEDINA
Suffix:
Gender:F
Credentials:ADVANCED PRACTICE NU
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1010 RICHARDS DR
Mailing Address - Street 2:
Mailing Address - City:LINWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08221-1119
Mailing Address - Country:US
Mailing Address - Phone:609-442-2682
Mailing Address - Fax:
Practice Address - Street 1:598 NEW RD
Practice Address - Street 2:
Practice Address - City:LINWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08221-1241
Practice Address - Country:US
Practice Address - Phone:609-442-2682
Practice Address - Fax:609-653-6852
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-30
Last Update Date:2020-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ01007500363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontologyGroup - Single Specialty