Basic Information
| Provider Information | |||||||||
| NPI: | 1073244182 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | TORRES MEDINA | ||||||||
| FirstName: | NANCY | ||||||||
| MiddleName: | PATRICIA | ||||||||
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| Credential: | FNP-BC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 16106 BRUNSWICK DR | ||||||||
| Address2: | |||||||||
| City: | GOSHEN | ||||||||
| State: | IN | ||||||||
| PostalCode: | 465268933 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5743129433 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 808 N 3RD ST | ||||||||
| Address2: | |||||||||
| City: | GOSHEN | ||||||||
| State: | IN | ||||||||
| PostalCode: | 465287100 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5745340088 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/20/2022 | ||||||||
| LastUpdateDate: | 07/15/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/15/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WX0200X | 363LF0000X | IN | N | Nursing Service Providers | Registered Nurse | Oncology | 363LF0000X | 71012789A | IN | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.