Individual
IVY L LOPEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
10717 BROKEN ARROW TRL, FORT WORTH, TX 76108-4751
(903) 340-7972
Mailing address
10717 BROKEN ARROW TRL, FORT WORTH, TX 76108-4751
Taxonomy
Speciality
Code
Description
License number
State
164X00000X
Licensed Vocational Nurse
Primary
349833
TX
Other
Enumeration date
07/06/2020
Last updated
07/06/2020
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