Individual
JENA MARIE LOPEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1415 E KINCAID STREET, MOUNT VERNON, WA 98274-4126
(360) 424-4111
Mailing address
1415 E KINCAID STREET, MOUNT VERNON, WA 98274-4126
(360) 424-4111
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
MD00048855
WA
208D00000X
General Practice Physician
MD00048855
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8509226
—
WA
Enumeration date
04/08/2006
Last updated
03/17/2016
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