Provider Demographics
NPI:1497962021
Name:LOPEZ, MIRIAN E (RN)
Entity type:Individual
Prefix:MS
First Name:MIRIAN
Middle Name:E
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:RN
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Other - First Name:
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Mailing Address - Street 1:9800 S HEALTHPARK DR
Mailing Address - Street 2:SUITE 410
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33908-7603
Mailing Address - Country:US
Mailing Address - Phone:239-433-6760
Mailing Address - Fax:239-433-6766
Practice Address - Street 1:2295 VICTORIA AVE
Practice Address - Street 2:SUITE 112
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33901-3884
Practice Address - Country:US
Practice Address - Phone:239-461-7633
Practice Address - Fax:239-461-7639
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-16
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLRN9172308163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management