Healthcare Provider Details

I. General information

NPI: 1841014404
Provider Name (Legal Business Name): MEDISON LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/11/2024
Last Update Date: 12/03/2024
Certification Date: 11/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1420 NOBLE FIRS CT SE
LACEY WA
98503-8620
US

IV. Provider business mailing address

1420 NOBLE FIRS CT SE
LACEY WA
98503-8620
US

V. Phone/Fax

Practice location:
  • Phone: 360-706-7683
  • Fax:
Mailing address:
  • Phone: 360-706-7683
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: GILBERT KORIR
Title or Position: DIRECTOR
Credential:
Phone: 360-706-7683