Healthcare Provider Details

I. General information

NPI: 1174419725
Provider Name (Legal Business Name): DAISY MEDRANO FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2025
Last Update Date: 06/18/2025
Certification Date: 06/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1993 ERRECART BLVD
ELKO NV
89801-8334
US

IV. Provider business mailing address

574 S 4TH ST
ELKO NV
89801-4107
US

V. Phone/Fax

Practice location:
  • Phone: 775-753-1049
  • Fax:
Mailing address:
  • Phone: 775-934-3804
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number821056
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: