Provider Demographics
NPI:1265741938
Name:LOPEZ, MEGHAN ELISE (CRNP)
Entity type:Individual
Prefix:MRS
First Name:MEGHAN
Middle Name:ELISE
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:MEGHAN
Other - Middle Name:ELISE
Other - Last Name:BODKIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:19217 SPOTSWOOD GLADE DR
Mailing Address - Street 2:
Mailing Address - City:GORDONSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22942-8025
Mailing Address - Country:US
Mailing Address - Phone:443-635-6040
Mailing Address - Fax:
Practice Address - Street 1:19217 SPOTSWOOD GLADE DR
Practice Address - Street 2:
Practice Address - City:GORDONSVILLE
Practice Address - State:VA
Practice Address - Zip Code:22942-8025
Practice Address - Country:US
Practice Address - Phone:443-635-6040
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-29
Last Update Date:2022-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR178806363LF0000X
VA0024179797363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily