Provider Demographics
NPI:1679058580
Name:LOPEZ, ANA LAURA (LVN)
Entity Type:Individual
Prefix:
First Name:ANA
Middle Name:LAURA
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1767 GINEBRA
Mailing Address - Street 2:
Mailing Address - City:EAGLE PASS
Mailing Address - State:TX
Mailing Address - Zip Code:78852-6552
Mailing Address - Country:US
Mailing Address - Phone:830-335-7967
Mailing Address - Fax:
Practice Address - Street 1:1767 GINEBRA
Practice Address - Street 2:
Practice Address - City:EAGLE PASS
Practice Address - State:TX
Practice Address - Zip Code:78852-6552
Practice Address - Country:US
Practice Address - Phone:830-335-7967
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-26
Last Update Date:2018-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX324868164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse