Healthcare Provider Details

I. General information

NPI: 1568970093
Provider Name (Legal Business Name): ASHLEY ANDREA WARD-LOPEZ RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/18/2018
Last Update Date: 01/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

420 MALL BLVD
SAVANNAH GA
31406-4888
US

IV. Provider business mailing address

1276 BAXTER ST
HINESVILLE GA
31313-8178
US

V. Phone/Fax

Practice location:
  • Phone: 912-644-5815
  • Fax:
Mailing address:
  • Phone: 912-398-8001
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License NumberRN241150
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License NumberRN241150
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code163WM0102X
TaxonomyMaternal Newborn Registered Nurse
License NumberRN241150
License Number StateGA
# 4
Primary TaxonomyN
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License NumberRN241150
License Number StateGA
# 5
Primary TaxonomyN
Taxonomy Code163WP1700X
TaxonomyPerinatal Registered Nurse
License NumberRN241150
License Number StateGA
# 6
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN241150
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: