Provider Demographics
NPI:1467478982
Name:LOPEZ, LILIANA (MSN, FNP, DNPC)
Entity Type:Individual
Prefix:
First Name:LILIANA
Middle Name:
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:MSN, FNP, DNPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 S MAIN ST
Mailing Address - Street 2:SUITE E
Mailing Address - City:SPRING VALLEY
Mailing Address - State:NY
Mailing Address - Zip Code:10977-4917
Mailing Address - Country:US
Mailing Address - Phone:845-499-5496
Mailing Address - Fax:845-290-1435
Practice Address - Street 1:25 S MAIN ST STE E
Practice Address - Street 2:
Practice Address - City:SPRING VALLEY
Practice Address - State:NY
Practice Address - Zip Code:10977-4917
Practice Address - Country:US
Practice Address - Phone:845-499-5496
Practice Address - Fax:845-290-1435
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-15
Last Update Date:2012-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY450396163W00000X
NYF334480-1363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse