| Doctor Name: | MRS. WANDA IVETTE LOPEZ-RODRIGUEZ |
| NPI Number: | 1194020834 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | NP-C |
| License Number: | 26NJ00325900 |
| Business Practice Address: | 1105 Route 46 Ledgewood, NJ - 07852 |
| Business Phone Number: | 9739274662 |
| Business Fax Number: | 9739274668 |
| Mailing Address: | 161 Mount Olive Rd, FLANDERS |
| State: | NJ |
| Postal Code: | 078369725 |
| Phone Number: | 9735274722 |
| Fax Number: | |
| NPI Enumeration Date: | 01/11/2011 |
| NPI Last Update Date: | 05/25/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 364SF0001X |
| License Number: | 26NJ00325900 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NJ |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Clinical Nurse Specialist |
| Taxonomy Specialization: | Family Health |
| Taxonomy Definition: | |