Provider Demographics
NPI:1437531746
Name:LOPEZ, NINA LYNN
Entity Type:Individual
Prefix:MISS
First Name:NINA
Middle Name:LYNN
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 1:1076 ROUTE 216
Mailing Address - Street 2:
Mailing Address - City:POUGHQUAG
Mailing Address - State:NY
Mailing Address - Zip Code:12570-5623
Mailing Address - Country:US
Mailing Address - Phone:845-724-1229
Mailing Address - Fax:
Practice Address - Street 1:1076 ROUTE 216
Practice Address - Street 2:
Practice Address - City:POUGHQUAG
Practice Address - State:NY
Practice Address - Zip Code:12570-5623
Practice Address - Country:US
Practice Address - Phone:845-724-1229
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-23
Last Update Date:2015-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program