Provider Demographics
NPI:1295195675
Name:LOPEZ, GISELLE (LPN)
Entity Type:Individual
Prefix:
First Name:GISELLE
Middle Name:
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:240 N MAIN ST
Mailing Address - Street 2:APT E
Mailing Address - City:WILKES BARRE
Mailing Address - State:PA
Mailing Address - Zip Code:18702-4448
Mailing Address - Country:US
Mailing Address - Phone:570-899-4415
Mailing Address - Fax:
Practice Address - Street 1:240 N MAIN ST
Practice Address - Street 2:APT E
Practice Address - City:WILKES BARRE
Practice Address - State:PA
Practice Address - Zip Code:18702-4448
Practice Address - Country:US
Practice Address - Phone:570-899-4415
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-29
Last Update Date:2016-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPN301875164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse