Provider Demographics
NPI:1881266948
Name:MEDLIN, JOSHUA (CRNA)
Entity type:Individual
Prefix:
First Name:JOSHUA
Middle Name:
Last Name:MEDLIN
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:303 LONGVIEW TER
Mailing Address - Street 2:
Mailing Address - City:EASLEY
Mailing Address - State:SC
Mailing Address - Zip Code:29642-3020
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:JOSHUA MEDLIN USS GEORGE WASHINTON
Practice Address - Street 2:FPO AE
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:09550
Practice Address - Country:US
Practice Address - Phone:864-901-7697
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-16
Last Update Date:2023-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC212986163WS0200X
SC25188367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163WS0200XNursing Service ProvidersRegistered NurseSchool