Provider Demographics
NPI:1265079602
Name:LOPEZ, CHARNELLE RENITA
Entity type:Individual
Prefix:
First Name:CHARNELLE
Middle Name:RENITA
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9603 HOMESTEAD RD APT 40C
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77016-4470
Mailing Address - Country:US
Mailing Address - Phone:346-247-4093
Mailing Address - Fax:
Practice Address - Street 1:9603 HOMESTEAD RD APT 40C
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77016-4470
Practice Address - Country:US
Practice Address - Phone:346-247-4093
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-04
Last Update Date:2019-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX979558163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse