Provider Demographics
NPI:1043788748
Name:MEDINA, LYNDSAY DAWN (LVN)
Entity Type:Individual
Prefix:
First Name:LYNDSAY
Middle Name:DAWN
Last Name:MEDINA
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4102 FREESTONE ST
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78222-4838
Mailing Address - Country:US
Mailing Address - Phone:210-328-4610
Mailing Address - Fax:
Practice Address - Street 1:4102 FREESTONE ST
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78222-4838
Practice Address - Country:US
Practice Address - Phone:210-328-4610
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-12
Last Update Date:2018-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX337680164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse