Provider Demographics
NPI:1093957359
Name:LOPEZ, JEANNE MARIE (RN, BSN)
Entity Type:Individual
Prefix:MRS
First Name:JEANNE
Middle Name:MARIE
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:RN, BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19141 STONE OAK PKWY
Mailing Address - Street 2:SUITE 104 BOX 42
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78258-3366
Mailing Address - Country:US
Mailing Address - Phone:210-832-8111
Mailing Address - Fax:210-832-8117
Practice Address - Street 1:19141 STONE OAK PKWY
Practice Address - Street 2:SUITE 104 BOX 42
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258-3366
Practice Address - Country:US
Practice Address - Phone:210-832-8111
Practice Address - Fax:210-832-8117
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-01
Last Update Date:2009-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX753777163W00000X, 171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty
No171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty