Provider Demographics
NPI:1275231110
Name:LOPES, ANITA FELIX (PMHNP)
Entity Type:Individual
Prefix:MRS
First Name:ANITA
Middle Name:FELIX
Last Name:LOPES
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:MS
Other - First Name:ANITA
Other - Middle Name:ALEXIS
Other - Last Name:NATHAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PMHNP
Mailing Address - Street 1:21 PENFIELD DR
Mailing Address - Street 2:
Mailing Address - City:LATHAM
Mailing Address - State:NY
Mailing Address - Zip Code:12110-5467
Mailing Address - Country:US
Mailing Address - Phone:410-855-0438
Mailing Address - Fax:
Practice Address - Street 1:21 PENFIELD DR
Practice Address - Street 2:
Practice Address - City:LATHAM
Practice Address - State:NY
Practice Address - Zip Code:12110-5467
Practice Address - Country:US
Practice Address - Phone:410-855-0438
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-20
Last Update Date:2023-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY767338163W00000X
NYF405000363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse