Provider Demographics
NPI:1053451021
Name:LOPEZ, GLENNA (FNP)
Entity Type:Individual
Prefix:
First Name:GLENNA
Middle Name:
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7024 COLONIAL RD
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11209-1110
Mailing Address - Country:US
Mailing Address - Phone:718-491-4538
Mailing Address - Fax:718-246-8570
Practice Address - Street 1:7024 COLONIAL RD
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11209-1110
Practice Address - Country:US
Practice Address - Phone:718-491-4538
Practice Address - Fax:718-246-8570
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF334079-1363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily