Individual
DESTINY MEDINA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
325 ILLINOIS RT 2, DIXON, IL 61021-9118
(815) 284-6611
Mailing address
325 ILLINOIS RT 2, DIXON, IL 61021-9118
Taxonomy
Speciality
Code
Description
License number
State
163WP0808X
Psychiatric/Mental Health Registered Nurse
Primary
04191066
IL
Other
Enumeration date
02/24/2021
Last updated
02/24/2021
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