Healthcare Provider Details

I. General information

NPI: 1679942320
Provider Name (Legal Business Name): RHONDA MEDINA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2015
Last Update Date: 09/23/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

560 GAGE BLVD SUITE 203
RICHLAND WA
99352-8650
US

IV. Provider business mailing address

888 SWIFT BLVD
RICHLAND WA
99352-3514
US

V. Phone/Fax

Practice location:
  • Phone: 509-942-3627
  • Fax: 509-942-2268
Mailing address:
  • Phone: 509-946-4611
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License NumberRN00119378
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: