Provider Demographics
NPI:1255031530
Name:CARRILLO LOPEZ, SINDY IVELSSE (DNP, ARNP, FNP-C)
Entity type:Individual
Prefix:DR
First Name:SINDY
Middle Name:IVELSSE
Last Name:CARRILLO LOPEZ
Suffix:
Gender:F
Credentials:DNP, ARNP, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:208 W CORRY CT
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:IA
Mailing Address - Zip Code:52641-2639
Mailing Address - Country:US
Mailing Address - Phone:319-201-0331
Mailing Address - Fax:
Practice Address - Street 1:407 S WHITE ST
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:IA
Practice Address - Zip Code:52641-2263
Practice Address - Country:US
Practice Address - Phone:319-385-3141
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-06
Last Update Date:2023-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA173482363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAA173482OtherIOWA BOARD OF NURSING