Provider Demographics
NPI:1497533053
Name:NONGUESKWA-LOPEZ, STACEY ANN
Entity Type:Individual
Prefix:MS
First Name:STACEY
Middle Name:ANN
Last Name:NONGUESKWA-LOPEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:STACEY
Other - Middle Name:ANN
Other - Last Name:NONGUESKWA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3625 ZHOW NOONG CIR
Mailing Address - Street 2:
Mailing Address - City:HARBOR SPRINGS
Mailing Address - State:MI
Mailing Address - Zip Code:49740-8857
Mailing Address - Country:US
Mailing Address - Phone:231-622-2571
Mailing Address - Fax:
Practice Address - Street 1:3625 ZHOW NOONG CIR
Practice Address - Street 2:
Practice Address - City:HARBOR SPRINGS
Practice Address - State:MI
Practice Address - Zip Code:49740-8857
Practice Address - Country:US
Practice Address - Phone:231-622-2571
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-15
Last Update Date:2023-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374J00000XNursing Service Related ProvidersDoulaGroup - Single Specialty