Basic Information
| Provider Information | |||||||||
| NPI: | 1437585890 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LOPEZ | ||||||||
| FirstName: | ANN MARIE BERNARDINE | ||||||||
| MiddleName: | PABLO | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 214 E 23RD ST | ||||||||
| Address2: | CHEYENNE REGIONAL MEDICAL CENTER | ||||||||
| City: | CHEYENNE | ||||||||
| State: | WY | ||||||||
| PostalCode: | 820013748 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 214 E 23RD ST | ||||||||
| Address2: | CHEYENNE REGIONAL MEDICAL CENTER | ||||||||
| City: | CHEYENNE | ||||||||
| State: | WY | ||||||||
| PostalCode: | 820013748 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3076342273 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/17/2013 | ||||||||
| LastUpdateDate: | 11/04/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 11/04/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | TL3430 | WY | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | 57.022692 | OH | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | 10718A | WY | N | Allopathic & Osteopathic Physicians | Internal Medicine | 208M00000X | 10718A | WY | Y | Allopathic & Osteopathic Physicians | Hospitalist |
No ID Information.