Provider Demographics
NPI:1962088815
Name:SILVA WANDERLEY LOPES, NATHALIA RAYANE (MD)
Entity type:Individual
Prefix:
First Name:NATHALIA
Middle Name:RAYANE
Last Name:SILVA WANDERLEY LOPES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3434 12TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98506-5175
Mailing Address - Country:US
Mailing Address - Phone:360-413-8470
Mailing Address - Fax:360-413-8819
Practice Address - Street 1:3434 12TH AVE NE
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98506-5175
Practice Address - Country:US
Practice Address - Phone:360-413-8470
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-22
Last Update Date:2024-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD61564303208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics