MEDICARE: MRS. LORENZA NONE LOPEZ WYSONG PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363AM0700X	Medical Physician Assistant	1896	AZ

General Provider Information

NPI Number	:	1568558963
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LORENZA NONE LOPEZ WYSONG PA

Provider Business Mailing Address
First Line	:	3533 CANYON DE FLORES, STE A
Second Line	:
City	:	SIERRA VISTA
State	:	AZ
Zip	:	85650-5366
Country	:	US
Telephone Number	:	520-803-7640
Fax Number	:	520-803-7886

Provider Business Practice Location Address
First Line	:	3533 CANYON DE FLORES, STE A
Second Line	:
City	:	SIERRA VISTA
State	:	AZ
Zip	:	85650-5366
Country	:	US
Telephone Number	:	520-803-7640
Fax Number	:	520-803-7886

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/04/2006
Last Update Date	:	10/05/2007

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