Provider Demographics
NPI:1366901795
Name:MEDAN, JOLIE ELIZABETH (BSN)
Entity type:Individual
Prefix:MRS
First Name:JOLIE
Middle Name:ELIZABETH
Last Name:MEDAN
Suffix:
Gender:F
Credentials:BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14108 N 156TH CT
Mailing Address - Street 2:
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85379-5639
Mailing Address - Country:US
Mailing Address - Phone:253-632-4014
Mailing Address - Fax:
Practice Address - Street 1:14108 N 156TH CT
Practice Address - Street 2:
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85379-5639
Practice Address - Country:US
Practice Address - Phone:253-632-4014
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-15
Last Update Date:2019-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN168967163WE0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WE0003XNursing Service ProvidersRegistered NurseEmergency