Provider Demographics
NPI:1346794286
Name:LOPEZ, JENNIFER ELISE (MS, RDN, LD)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:ELISE
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:MS, RDN, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1041 SUNFLOWER
Mailing Address - Street 2:
Mailing Address - City:PARADISE
Mailing Address - State:TX
Mailing Address - Zip Code:76073-3219
Mailing Address - Country:US
Mailing Address - Phone:682-554-5708
Mailing Address - Fax:940-828-1460
Practice Address - Street 1:1041 SUNFLOWER
Practice Address - Street 2:
Practice Address - City:PARADISE
Practice Address - State:TX
Practice Address - Zip Code:76073-3219
Practice Address - Country:US
Practice Address - Phone:682-554-5708
Practice Address - Fax:940-828-1460
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-09
Last Update Date:2024-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT83661133V00000X
TX21700275163WD0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator