Provider Demographics
NPI:1356849632
Name:LOPEZ, JESSICA CAROLINA
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:CAROLINA
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13 VINE ST
Mailing Address - Street 2:
Mailing Address - City:NYACK
Mailing Address - State:NY
Mailing Address - Zip Code:10960-3403
Mailing Address - Country:US
Mailing Address - Phone:845-893-5908
Mailing Address - Fax:
Practice Address - Street 1:20 OLD TURNPIKE RD STE 307
Practice Address - Street 2:
Practice Address - City:NANUET
Practice Address - State:NY
Practice Address - Zip Code:10954-2530
Practice Address - Country:US
Practice Address - Phone:845-624-0260
Practice Address - Fax:845-624-0264
Is Sole Proprietor?:No
Enumeration Date:2018-02-01
Last Update Date:2018-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY331103164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse