Provider Demographics
NPI:1861930364
Name:MEDLEY, LANORA (RN, CDE)
Entity type:Individual
Prefix:MRS
First Name:LANORA
Middle Name:
Last Name:MEDLEY
Suffix:
Gender:F
Credentials:RN, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1655 COUNTY ROAD 123
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:AL
Mailing Address - Zip Code:36319-5745
Mailing Address - Country:US
Mailing Address - Phone:334-618-1824
Mailing Address - Fax:
Practice Address - Street 1:1655 COUNTY ROAD 123
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:AL
Practice Address - Zip Code:36319-5745
Practice Address - Country:US
Practice Address - Phone:334-618-1824
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-03
Last Update Date:2017-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-054943163WD0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator