Provider Demographics
NPI:1821272063
Name:LOPEZ, KRISTIE LEA (RN)
Entity Type:Individual
Prefix:
First Name:KRISTIE
Middle Name:LEA
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 TELEPHRAGH AVENUE
Mailing Address - Street 2:
Mailing Address - City:CHICOPEE
Mailing Address - State:MA
Mailing Address - Zip Code:01020
Mailing Address - Country:US
Mailing Address - Phone:413-532-3935
Mailing Address - Fax:
Practice Address - Street 1:273 STATE ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01103-1950
Practice Address - Country:US
Practice Address - Phone:413-736-3668
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-12-24
Last Update Date:2007-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA213119163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse