Healthcare Provider Details

I. General information

NPI: 1861930364
Provider Name (Legal Business Name): LANORA MEDLEY RN, CDE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/03/2017
Last Update Date: 02/03/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1655 COUNTY ROAD 123
COLUMBIA AL
36319-5745
US

IV. Provider business mailing address

1655 COUNTY ROAD 123
COLUMBIA AL
36319-5745
US

V. Phone/Fax

Practice location:
  • Phone: 334-618-1824
  • Fax:
Mailing address:
  • Phone: 334-618-1824
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WD0400X
TaxonomyDiabetes Educator Registered Nurse
License Number1-054943
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: