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General NPI Number Information
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NPI Number | 1033080353
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Entity Type | Individual
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Provider Name | TERRIANN LORRAINE MEDINA CAPRC
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Gender | Male
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Dates
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Enumeration Date | 09/17/2025
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Last Update Date | 09/17/2025
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Provider Practice Location Address
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Address Line | 13699 US 50
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City | DILLSBORO
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State | IN
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Zip | 47018-9642
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Country | US
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Telephone | 812-621-2481
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Fax |
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Provider Business Mailing Address
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Address Line | 13699 US 50
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City | DILLSBORO
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State | IN
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Zip | 47018-9642
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Country | US
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Telephone | 812-621-2481
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 172V00000X
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Taxonomy Name | Community Health Worker
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License Number | 190004897
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 175T00000X
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Taxonomy Name | Peer Specialist
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License Number | CAPRC2-5662
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License Number State | IN
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