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General NPI Number Information
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NPI Number | 1356869325
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Entity Type | Individual
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Provider Name | JESSE RAMONE MEDINA CRNA
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Gender | Male
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Dates
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Enumeration Date | 08/30/2017
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Last Update Date | 01/13/2026
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Provider Practice Location Address
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Address Line | 1000 N OAK AVE
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City | MARSHFIELD
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State | WI
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Zip | 54449-5703
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Country | US
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Telephone | 715-387-5511
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Fax | 715-387-5240
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Provider Business Mailing Address
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Address Line | 1508 N SHAWANO DR
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City | MARSHFIELD
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State | WI
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Zip | 54449-1350
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Country | US
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Telephone | 956-579-5081
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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 | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 9050-33
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 0024182743
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License Number State | VA
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Taxonomy #3
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 770560
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License Number State | TX
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Taxonomy #4
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 4012936
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License Number State | KY
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Taxonomy #5
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 32989
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License Number State | TN
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