Provider Demographics
NPI:1750198198
Name:URZUA MEDINA, NANCY
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:
Last Name:URZUA MEDINA
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 1:23200 NE SANDY BLVD UNIT 23
Mailing Address - Street 2:
Mailing Address - City:WOOD VILLAGE
Mailing Address - State:OR
Mailing Address - Zip Code:97060-9607
Mailing Address - Country:US
Mailing Address - Phone:503-676-4571
Mailing Address - Fax:
Practice Address - Street 1:23200 NE SANDY BLVD UNIT 23
Practice Address - Street 2:
Practice Address - City:WOOD VILLAGE
Practice Address - State:OR
Practice Address - Zip Code:97060-9607
Practice Address - Country:US
Practice Address - Phone:503-676-4571
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-17
Last Update Date:2024-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR112853374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula