MEDICARE: MISS ANDRIANNA MICHELLE MEDINA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	917251	TX

General Provider Information

NPI Number	:	1942809132
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS ANDRIANNA MICHELLE MEDINA

Provider Business Mailing Address
First Line	:	1855 TOM BOLT DR
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79936-4217
Country	:	US
Telephone Number	:	915-202-8568
Fax Number	:

Provider Business Practice Location Address
First Line	:	1855 TOM BOLT DR
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79936-4217
Country	:	US
Telephone Number	:	915-202-8568
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/20/2020
Last Update Date	:	10/20/2020

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