Provider Demographics
NPI:1215932009
Name:MEDINA, MARIA D (ARNP)
Entity type:Individual
Prefix:MRS
First Name:MARIA
Middle Name:D
Last Name:MEDINA
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 47669
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67201-7669
Mailing Address - Country:US
Mailing Address - Phone:316-712-9235
Mailing Address - Fax:316-219-4141
Practice Address - Street 1:9350 E 35TH ST N
Practice Address - Street 2:SUITE 101
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67226-2019
Practice Address - Country:US
Practice Address - Phone:316-265-1308
Practice Address - Fax:316-265-4480
Is Sole Proprietor?:No
Enumeration Date:2005-06-17
Last Update Date:2016-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS53-74537363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100428600BMedicaid
KS111203022Medicare PIN