Provider Demographics
NPI:1942674940
Name:LOPEZ, WYNTER DIONDRA
Entity Type:Individual
Prefix:
First Name:WYNTER
Middle Name:DIONDRA
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1101 HENSLEY RD
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30642-1905
Mailing Address - Country:US
Mailing Address - Phone:706-817-6030
Mailing Address - Fax:
Practice Address - Street 1:1101 HENSLEY RD
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:GA
Practice Address - Zip Code:30642-1905
Practice Address - Country:US
Practice Address - Phone:706-817-6030
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-15
Last Update Date:2015-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide