Provider Demographics
NPI:1093478802
Name:LOPEZ, EMMA RENAY (PA-C)
Entity Type:Individual
Prefix:
First Name:EMMA
Middle Name:RENAY
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:EMMA
Other - Middle Name:RENAY
Other - Last Name:SAMPLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:182 CAMBRIDGE LN
Mailing Address - Street 2:
Mailing Address - City:LEWISTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:17044-9315
Mailing Address - Country:US
Mailing Address - Phone:330-814-3071
Mailing Address - Fax:
Practice Address - Street 1:400 HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:LEWISTOWN
Practice Address - State:PA
Practice Address - Zip Code:17044-1167
Practice Address - Country:US
Practice Address - Phone:717-242-7145
Practice Address - Fax:717-242-7729
Is Sole Proprietor?:No
Enumeration Date:2021-10-19
Last Update Date:2023-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty