Individual
JENNIFER LYNN MEDINA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CNP
Contact information
Practice address
3741 RUTLEDGE RD NE, ALBUQUERQUE, NM 87109-5566
(505) 798-9300
Mailing address
4701 MONTGOMERY BLVD NE, ALBUQUERQUE, NM 87109-1219
(505) 727-6853
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
76871
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
76871
NM LICENSE
NM
Enumeration date
11/22/2023
Last updated
02/19/2024
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