Provider Demographics
NPI:1952742413
Name:MEDLEY, EUGENIE D (LPN)
Entity Type:Individual
Prefix:MS
First Name:EUGENIE
Middle Name:D
Last Name:MEDLEY
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:57 BEERS DR
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:NY
Mailing Address - Zip Code:10940-4220
Mailing Address - Country:US
Mailing Address - Phone:407-873-1491
Mailing Address - Fax:
Practice Address - Street 1:57 BEERS DR
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:NY
Practice Address - Zip Code:10940-4220
Practice Address - Country:US
Practice Address - Phone:845-479-9414
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-12
Last Update Date:2022-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY304964-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse