Healthcare Provider Details

I. General information

NPI: 1023044492
Provider Name (Legal Business Name): CRISANTA P MEDINA-NOEL APRN-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2006
Last Update Date: 07/09/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 GUSTAVE L LEVY PL BOX 1495
NEW YORK NY
10029-6500
US

IV. Provider business mailing address

1 GUSTAVE L LEVY PL BOX 1495
NEW YORK NY
10029-6500
US

V. Phone/Fax

Practice location:
  • Phone: 212-241-8095
  • Fax:
Mailing address:
  • Phone: 212-241-8095
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF496303-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: