Individual
JEFFERY MICHAEL MEDINA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
RN
Contact information
Practice address
455 SAINT MICHAELS DR, SANTA FE, NM 87505-7601
(505) 913-5503
Mailing address
4241 HOWLING WOLF LN, SANTA FE, NM 87507-0815
(505) 515-4295
Taxonomy
Speciality
Code
Description
License number
State
163WM0705X
Medical-Surgical Registered Nurse
Primary
RN-81127
NM
Other
Enumeration date
02/17/2017
Last updated
02/17/2017
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