Provider Demographics
NPI:1073142295
Name:LOPEZ, GRACE ANN (BSN, RN)
Entity Type:Individual
Prefix:
First Name:GRACE
Middle Name:ANN
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:BSN, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34234 VAUXHILL DR
Mailing Address - Street 2:
Mailing Address - City:PAW PAW
Mailing Address - State:MI
Mailing Address - Zip Code:49079-9543
Mailing Address - Country:US
Mailing Address - Phone:269-377-5001
Mailing Address - Fax:
Practice Address - Street 1:601 JOHN ST STE M-170
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49007-5366
Practice Address - Country:US
Practice Address - Phone:269-381-7169
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-08
Last Update Date:2020-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704253889163WP2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP2201XNursing Service ProvidersRegistered NurseAmbulatory Care