Provider Demographics
NPI:1255858072
Name:LOPEZ, ORCHID M (RN)
Entity Type:Individual
Prefix:
First Name:ORCHID
Middle Name:M
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:ORCHID
Other - Middle Name:LEE
Other - Last Name:MOLINA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN
Mailing Address - Street 1:5560 W MEGAN ST
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85226-6810
Mailing Address - Country:US
Mailing Address - Phone:602-377-5621
Mailing Address - Fax:
Practice Address - Street 1:4502 N CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85012-1817
Practice Address - Country:US
Practice Address - Phone:602-764-1025
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-23
Last Update Date:2017-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN049077163WA2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA2000XNursing Service ProvidersRegistered NurseAdministrator