Provider Demographics
NPI:1558952069
Name:LOPEZ, CHELSEA (FNP-C)
Entity Type:Individual
Prefix:DR
First Name:CHELSEA
Middle Name:
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 792
Mailing Address - Street 2:
Mailing Address - City:OKANOGAN
Mailing Address - State:WA
Mailing Address - Zip Code:98840-0792
Mailing Address - Country:US
Mailing Address - Phone:509-207-4105
Mailing Address - Fax:
Practice Address - Street 1:500 W CUMMINGS PARK STE 2550
Practice Address - Street 2:
Practice Address - City:WOBURN
Practice Address - State:MA
Practice Address - Zip Code:01801-6500
Practice Address - Country:US
Practice Address - Phone:781-376-6944
Practice Address - Fax:781-933-0595
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-27
Last Update Date:2021-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP61053323363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner