Provider Demographics
NPI:1437744976
Name:LOPEZ, MICHAEL J (CRNP (FAMILY HEALTH))
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:J
Last Name:LOPEZ
Suffix:
Gender:M
Credentials:CRNP (FAMILY HEALTH)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3811 PATTON ST
Mailing Address - Street 2:
Mailing Address - City:READING
Mailing Address - State:PA
Mailing Address - Zip Code:19606-2854
Mailing Address - Country:US
Mailing Address - Phone:717-580-6559
Mailing Address - Fax:
Practice Address - Street 1:512 DEKALB ST
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:PA
Practice Address - Zip Code:19405-1134
Practice Address - Country:US
Practice Address - Phone:610-787-8000
Practice Address - Fax:610-270-2834
Is Sole Proprietor?:No
Enumeration Date:2021-03-06
Last Update Date:2022-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASPO23390363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily