Individual
DR. SHANEISH NUGENT LOPEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
EASTERN IDAHO REGIONAL MEDICAL CTR, 3100 CHANNING WAY, IDAHO FALLS, ID 83404
(208) 227-2850
Mailing address
EASTERN IDAHO REGIONAL MEDICAL CTR, 3100 CHANNING WAY, IDAHO FALLS, ID 83404
(208) 227-2850
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
03/25/2025
Last updated
03/25/2025
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