Provider Demographics
NPI:1235501263
Name:LOPEZ, MAYRA LUCIA (FNP-C)
Entity Type:Individual
Prefix:
First Name:MAYRA
Middle Name:LUCIA
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1670 W RUTHRAUFF RD
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85705-1253
Mailing Address - Country:US
Mailing Address - Phone:520-616-6797
Mailing Address - Fax:
Practice Address - Street 1:1670 W RUTHRAUFF RD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85705-1253
Practice Address - Country:US
Practice Address - Phone:520-616-6797
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-29
Last Update Date:2017-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP129516363LF0000X
AZAP10574363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily