Provider Demographics
NPI:1629544077
Name:MEDINA, MARIA CLAUDIA (LVN)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:CLAUDIA
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 1:2307 SMUTS DR
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75701-2442
Mailing Address - Country:US
Mailing Address - Phone:903-780-3894
Mailing Address - Fax:
Practice Address - Street 1:2307 SMUTS DR
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75701-2442
Practice Address - Country:US
Practice Address - Phone:903-780-3894
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-23
Last Update Date:2018-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX316089164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse