Provider Demographics
NPI:1467934489
Name:LOPEZ, DENISE NICOLE (RN)
Entity Type:Individual
Prefix:MS
First Name:DENISE
Middle Name:NICOLE
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:MASTIC
Mailing Address - State:NY
Mailing Address - Zip Code:11950-2509
Mailing Address - Country:US
Mailing Address - Phone:347-260-2303
Mailing Address - Fax:
Practice Address - Street 1:102 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:MASTIC
Practice Address - State:NY
Practice Address - Zip Code:11950-2509
Practice Address - Country:US
Practice Address - Phone:347-260-2303
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-06
Last Update Date:2022-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY568444163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse