Provider Demographics
NPI:1679946701
Name:LOPEZ, DIANA JACQUELINE (BSN, RN)
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:JACQUELINE
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:BSN, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1643 PUTNAM AVE
Mailing Address - Street 2:APT 3L
Mailing Address - City:RIDGEWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:11385-3420
Mailing Address - Country:US
Mailing Address - Phone:347-725-7588
Mailing Address - Fax:
Practice Address - Street 1:1643 PUTNAM AVE
Practice Address - Street 2:APT 3L
Practice Address - City:RIDGEWOOD
Practice Address - State:NY
Practice Address - Zip Code:11385-3420
Practice Address - Country:US
Practice Address - Phone:347-725-7588
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-11
Last Update Date:2015-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY704888163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse