Provider Demographics
NPI:1255822995
Name:LOPEZ, JUDITH MARIE (LVN)
Entity type:Individual
Prefix:MS
First Name:JUDITH
Middle Name:MARIE
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:JUDITH
Other - Middle Name:MARIE
Other - Last Name:REYNA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LVN
Mailing Address - Street 1:10417 SUNFLOWER DR
Mailing Address - Street 2:
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76708-5639
Mailing Address - Country:US
Mailing Address - Phone:254-230-7577
Mailing Address - Fax:
Practice Address - Street 1:10417 SUNFLOWER DR
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76708-5639
Practice Address - Country:US
Practice Address - Phone:254-230-7577
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-29
Last Update Date:2018-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX326773164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse