Healthcare Provider Details

I. General information

NPI: 1487656112
Provider Name (Legal Business Name): DAISY MEDINA-KREPPEIN NURSE PRACTITIONER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: DAISY MEDINA-KREPPEIN DNP, FNP-BC

II. Dates (important events)

Enumeration Date: 08/12/2005
Last Update Date: 08/16/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2280 N OCEAN AVE INSIDE KMART
FARMINGVILLE NY
11738-2911
US

IV. Provider business mailing address

8315 98TH ST APT 2C
WOODHAVEN NY
11421-1601
US

V. Phone/Fax

Practice location:
  • Phone: 631-282-8450
  • Fax: 631-320-1300
Mailing address:
  • Phone: 718-850-5077
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number491154
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number334130
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: