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General NPI Number Information
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NPI Number | 1265780241
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Entity Type | Individual
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Provider Name | JEANETTE LOPEZ C.B.R.F CERTIFIED
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Gender | Female
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Dates
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Enumeration Date | 08/22/2012
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Last Update Date | 08/22/2012
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Provider Practice Location Address
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Address Line | 332 N 40TH ST
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City | MILWAUKEE
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State | WI
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Zip | 53208-3739
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Country | US
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Telephone | 414-315-7573
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Fax | 414-489-7395
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Provider Business Mailing Address
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Address Line | 332 N 40TH ST
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City | MILWAUKEE
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State | WI
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Zip | 53208-3739
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Country | US
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Telephone | 414-315-7573
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Fax | 414-489-7395
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 374U00000X
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Taxonomy Name | Home Health Aide
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License Number |
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License Number State |
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