Individual
MS. JORDYN LOPEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS, LAT, ATC
Contact information
Practice address
400 ATLANTIC CHRISTIAN COL DR NE, WILSON, NC 27893-2505
(440) 231-7666
Mailing address
400 ATLANTIC CHRISTIAN COL DR NE, WILSON, NC 27893-2575
(440) 231-7666
Taxonomy
Speciality
Code
Description
License number
State
146N00000X
Basic Emergency Medical Technician
0176569
OH
2255A2300X
Athletic Trainer
Primary
2000032760
—
2255A2300X
Athletic Trainer
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
105800774-00
—
OH
Enumeration date
08/30/2017
Last updated
11/27/2023
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