Provider Demographics
NPI:1093595811
Name:HAGENMAYER-LOPEZ, NANCY ANNE (LMT)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:ANNE
Last Name:HAGENMAYER-LOPEZ
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39 KELLAM RD
Mailing Address - Street 2:
Mailing Address - City:EQUINUNK
Mailing Address - State:PA
Mailing Address - Zip Code:18417-3041
Mailing Address - Country:US
Mailing Address - Phone:516-330-6164
Mailing Address - Fax:
Practice Address - Street 1:39 KELLAM RD
Practice Address - Street 2:
Practice Address - City:EQUINUNK
Practice Address - State:PA
Practice Address - Zip Code:18417-3041
Practice Address - Country:US
Practice Address - Phone:516-330-6164
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-29
Last Update Date:2023-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005961-1225700000X
PAMSG011900225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist