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General NPI Number Information
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NPI Number | 1528150661
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Entity Type | Individual
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Provider Name | NICOLLE L MEDINA ARNP
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Gender | Female
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Dates
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Enumeration Date | 09/28/2006
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Last Update Date | 08/22/2025
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Provider Practice Location Address
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Address Line | 1817 1ST AVE E
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City | NEWTON
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State | IA
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Zip | 50208-4052
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Country | US
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Telephone | 641-458-3055
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Fax | 641-357-2857
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Provider Business Mailing Address
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Address Line | 1817 1ST AVE E
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City | NEWTON
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State | IA
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Zip | 50208-4052
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Country | US
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Telephone | 641-458-3055
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Fax | 641-357-2857
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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 | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | G166072
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License Number State | IA
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | A099623
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License Number State | IA
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