Provider Demographics
NPI:1538479969
Name:LOPEZ, EDWARD MAURICE (RN, MSN, FNP-BC)
Entity Type:Individual
Prefix:MR
First Name:EDWARD
Middle Name:MAURICE
Last Name:LOPEZ
Suffix:
Gender:M
Credentials:RN, MSN, FNP-BC
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:PO BOX 640
Mailing Address - Street 2:
Mailing Address - City:STANTON
Mailing Address - State:TX
Mailing Address - Zip Code:79782-0640
Mailing Address - Country:US
Mailing Address - Phone:432-607-3243
Mailing Address - Fax:432-607-3298
Practice Address - Street 1:600 EAST INTERSTATE 20
Practice Address - Street 2:
Practice Address - City:STANTON
Practice Address - State:TX
Practice Address - Zip Code:79782-0640
Practice Address - Country:US
Practice Address - Phone:432-607-3243
Practice Address - Fax:432-607-3644
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-19
Last Update Date:2023-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX705690363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX705690OtherBOARD OF NURSING APRN LICENSE