Provider Demographics
NPI:1053055087
Name:LOPEZ, YADIRA (FNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:YADIRA
Middle Name:
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:698 MULLICA HILL RD FL 3
Mailing Address - Street 2:
Mailing Address - City:MULLICA HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08062-4452
Mailing Address - Country:US
Mailing Address - Phone:856-508-3708
Mailing Address - Fax:
Practice Address - Street 1:698 MULLICA HILL RD FL 3
Practice Address - Street 2:
Practice Address - City:MULLICA HILL
Practice Address - State:NJ
Practice Address - Zip Code:08062-4452
Practice Address - Country:US
Practice Address - Phone:856-508-3708
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-26
Last Update Date:2023-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ01302700363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily