Healthcare Provider Details

I. General information

NPI: 1508461773
Provider Name (Legal Business Name): LINDSEY CORINNE MEDOIT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/03/2020
Last Update Date: 12/03/2020
Certification Date: 12/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2495 N 50TH ST APT 233C
PHILADELPHIA PA
19131-1443
US

IV. Provider business mailing address

2495 N 50TH ST APT 233C
PHILADELPHIA PA
19131-1443
US

V. Phone/Fax

Practice location:
  • Phone: 203-981-6219
  • Fax:
Mailing address:
  • Phone: 203-981-6219
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License NumberRN703943
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: