Individual
KELLY LAUREL LOPEZ
Active
Individual
KELLY LAUREL LOPEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
041374254
IL
163W00000X
Registered Nurse
54261
NM
367500000X
Certified Registered Nurse Anesthetist
209012263
IL
367500000X
Certified Registered Nurse Anesthetist
Primary
54261
NM
Other
Enumeration date
09/12/2014
Last updated
07/27/2022
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