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Individual

IVY LOPEZ

Active
Sole proprietor
No

Provider details

NPI number
Gender
F

Contact information

Practice address
905 E GENEVA ST, DELAVAN, WI 53115-1922
(262) 728-6319
Mailing address
W3831 DAHLIA DR, LAKE GENEVA, WI 53147-2827

Taxonomy

Speciality
Code
Description
License number
State
163WG0000X
General Practice Registered Nurse
Primary
125083-30
WI

Other

Enumeration date
12/24/2018
Last updated
12/24/2018
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