Provider Demographics
NPI:1811242662
Name:KUSURAN, MEDINA (RN)
Entity type:Individual
Prefix:MS
First Name:MEDINA
Middle Name:
Last Name:KUSURAN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MS
Other - First Name:MEDINA
Other - Middle Name:
Other - Last Name:KUSURAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN
Mailing Address - Street 1:1223 BEACON ST APT 316
Mailing Address - Street 2:
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02446-5391
Mailing Address - Country:US
Mailing Address - Phone:773-595-7066
Mailing Address - Fax:
Practice Address - Street 1:230 HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:SOMERVILLE
Practice Address - State:MA
Practice Address - Zip Code:02143-1408
Practice Address - Country:US
Practice Address - Phone:617-591-4500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-18
Last Update Date:2012-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2278038163WP2201X
IL041386287163WP2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP2201XNursing Service ProvidersRegistered NurseAmbulatory Care