| Doctor Name: | MRS. CANDY MEDINA |
| NPI Number: | 1366863235 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | RN |
| License Number: | R53615 |
| Business Practice Address: | 1301 Washington St 1301 West Washington Street Anthony, NM - 880218846 |
| Business Phone Number: | 5758826101 |
| Business Fax Number: | 5758826926 |
| Mailing Address: | 1301 Washington St, 1301 West Washington Street ANTHONY |
| State: | NM |
| Postal Code: | 880218846 |
| Phone Number: | 5758826101 |
| Fax Number: | 5758826926 |
| NPI Enumeration Date: | 12/19/2013 |
| NPI Last Update Date: | 12/19/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 163WS0200X |
| License Number: | R53615 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NM |
| Taxonomy Type: | Nursing Service Providers |
| Taxonomy Classification: | Registered Nurse |
| Taxonomy Specialization: | School |
| Taxonomy Definition: | |