Provider Demographics
NPI:1790127280
Name:LOPEZ, ESMERALDA B (LPN)
Entity Type:Individual
Prefix:MS
First Name:ESMERALDA
Middle Name:B
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9322 3RD AVE
Mailing Address - Street 2:#375
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11209-6802
Mailing Address - Country:US
Mailing Address - Phone:347-815-3673
Mailing Address - Fax:
Practice Address - Street 1:9322 3RD AVE
Practice Address - Street 2:#375
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11209-6802
Practice Address - Country:US
Practice Address - Phone:347-815-3673
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-24
Last Update Date:2013-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY313247164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse