Provider Demographics
NPI:1023369477
Name:LOPEZ, MELANIE BECKER (NP-C)
Entity Type:Individual
Prefix:
First Name:MELANIE
Middle Name:BECKER
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:MELANIE
Other - Middle Name:ANN
Other - Last Name:BECKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:1960 RIVERSIDE PKWY
Mailing Address - Street 2:SUITE 101
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30043-5945
Mailing Address - Country:US
Mailing Address - Phone:770-995-0466
Mailing Address - Fax:770-995-0472
Practice Address - Street 1:1960 RIVERSIDE PKWY
Practice Address - Street 2:SUITE 101
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30043-5945
Practice Address - Country:US
Practice Address - Phone:770-995-0466
Practice Address - Fax:770-995-0472
Is Sole Proprietor?:No
Enumeration Date:2012-09-25
Last Update Date:2012-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN056928363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health