Healthcare Provider Details

I. General information

NPI: 1093287047
Provider Name (Legal Business Name): ADELA MEDINA CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/31/2018
Last Update Date: 02/08/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

725 ALBANY STREET SHAPIRO 7, SUITE B
BOSTON MA
02118
US

IV. Provider business mailing address

720 HARRISON AVENUE DOB 503
BOSTON MA
02118
US

V. Phone/Fax

Practice location:
  • Phone: 617-638-8456
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN233647
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: