Provider Demographics
NPI:1851753503
Name:LOPEZ, CARRIE LYNN (NP-C)
Entity Type:Individual
Prefix:
First Name:CARRIE
Middle Name:LYNN
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2375 S RIDGEVIEW DR
Mailing Address - Street 2:
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85364-8868
Mailing Address - Country:US
Mailing Address - Phone:928-317-2518
Mailing Address - Fax:928-317-1811
Practice Address - Street 1:2375 S RIDGEVIEW DR
Practice Address - Street 2:
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85364-8868
Practice Address - Country:US
Practice Address - Phone:928-317-2518
Practice Address - Fax:928-317-1811
Is Sole Proprietor?:No
Enumeration Date:2016-03-22
Last Update Date:2016-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP8504363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily