Basic Information
| Provider Information | |||||||||
| NPI: | 1144522046 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MEDINA-VARGAS | ||||||||
| FirstName: | MONINA | ||||||||
| MiddleName: | CALAYAG | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1309 N. ELM STREET | ||||||||
| Address2: | |||||||||
| City: | GREENSBORO | ||||||||
| State: | NC | ||||||||
| PostalCode: | 274011005 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3365445400 | ||||||||
| FaxNumber: | 3365445401 | ||||||||
| Practice Location | |||||||||
| Address1: | 1309 N. ELM STREET | ||||||||
| Address2: | |||||||||
| City: | GREENSBORO | ||||||||
| State: | NC | ||||||||
| PostalCode: | 274011005 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3365445400 | ||||||||
| FaxNumber: | 3365445401 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/29/2010 | ||||||||
| LastUpdateDate: | 09/20/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/20/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LA2200X | 5005004 | NC | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Adult Health |
No ID Information.