Provider Demographics
NPI:1467949610
Name:LOPEZ DE PEREZ, CARRIE (RN)
Entity Type:Individual
Prefix:
First Name:CARRIE
Middle Name:
Last Name:LOPEZ DE PEREZ
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:CARRIE
Other - Middle Name:L
Other - Last Name:PEREZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN
Mailing Address - Street 1:9313 ACADEMY HILLS DR NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87111-1302
Mailing Address - Country:US
Mailing Address - Phone:505-350-7643
Mailing Address - Fax:
Practice Address - Street 1:900 ATLANTIC AVE SW
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87102-4014
Practice Address - Country:US
Practice Address - Phone:505-350-7643
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-13
Last Update Date:2018-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMRN-80379163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool