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General NPI Number Information
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NPI Number | 1013905850
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Entity Type | Individual
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Provider Name | DUANE MEDEIROS MSN-NP
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Gender | Male
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Dates
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Enumeration Date | 10/06/2005
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Last Update Date | 06/21/2022
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Provider Practice Location Address
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Address Line | 901 CAMPUS DR STE 102
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City | DALY CITY
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State | CA
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Zip | 94015-4930
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Country | US
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Telephone | 650-266-8242
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Fax |
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Provider Business Mailing Address
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Address Line | 2450 LAKESIDE PKWY STE 150-11
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City | FLOWER MOUND
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State | TX
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Zip | 75022-4120
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Country | US
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Telephone | 650-266-8242
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 559005
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License Number State | CA
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