Provider Demographics
NPI:1346530862
Name:LOPEZ, YAMIRA JOSEFINA (LPN)
Entity Type:Individual
Prefix:MRS
First Name:YAMIRA
Middle Name:JOSEFINA
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 1:171 HOLLAND AVE
Mailing Address - Street 2:
Mailing Address - City:ELMONT
Mailing Address - State:NY
Mailing Address - Zip Code:11003-1628
Mailing Address - Country:US
Mailing Address - Phone:347-729-6108
Mailing Address - Fax:516-270-3549
Practice Address - Street 1:171 HOLLAND AVE
Practice Address - Street 2:
Practice Address - City:ELMONT
Practice Address - State:NY
Practice Address - Zip Code:11003-1628
Practice Address - Country:US
Practice Address - Phone:347-729-6108
Practice Address - Fax:516-270-3549
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-18
Last Update Date:2011-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY267156-1164W00000X
NJ26NP06305700164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse