Individual
JOHN MEDINA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
909 CR 159, PINE BLUFFS, WY 82082
(307) 214-3115
Mailing address
PO BOX 204, CHEYENNE, WY 82003-0204
(307) 214-3115
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
11/04/2016
Last updated
11/04/2016
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