Provider Demographics
NPI:1225395726
Name:LOPEZ, EVELYN R (WHCNP)
Entity Type:Individual
Prefix:
First Name:EVELYN
Middle Name:R
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:WHCNP
Other - Prefix:
Other - First Name:EVELYN
Other - Middle Name:R
Other - Last Name:ALICEA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9520 W PALM LN STE 200
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85037-4403
Mailing Address - Country:US
Mailing Address - Phone:623-583-3001
Mailing Address - Fax:623-583-3007
Practice Address - Street 1:9520 W PALM LN STE 200
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85037-4403
Practice Address - Country:US
Practice Address - Phone:623-583-3001
Practice Address - Fax:623-583-3007
Is Sole Proprietor?:No
Enumeration Date:2012-04-20
Last Update Date:2014-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP4402363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology