Provider Demographics
NPI:1407660244
Name:MEDINA, CHRISTOPHER DAMIAN
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:DAMIAN
Last Name:MEDINA
Suffix:
Gender:U
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2545 S 39TH ST
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68506-2435
Mailing Address - Country:US
Mailing Address - Phone:402-840-5046
Mailing Address - Fax:
Practice Address - Street 1:2545 S 39TH ST
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68506-2435
Practice Address - Country:US
Practice Address - Phone:402-840-5046
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-03
Last Update Date:2025-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor