Provider Demographics
NPI:1669236899
Name:LOPEZ, ANDREA DENISE (PRSS)
Entity type:Individual
Prefix:MRS
First Name:ANDREA
Middle Name:DENISE
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:PRSS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 O HAGAN LN
Mailing Address - Street 2:
Mailing Address - City:THORNTON
Mailing Address - State:WV
Mailing Address - Zip Code:26440-7090
Mailing Address - Country:US
Mailing Address - Phone:681-622-1039
Mailing Address - Fax:
Practice Address - Street 1:26 O HAGAN LN
Practice Address - Street 2:
Practice Address - City:THORNTON
Practice Address - State:WV
Practice Address - Zip Code:26440-7090
Practice Address - Country:US
Practice Address - Phone:681-622-1039
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-08
Last Update Date:2024-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175T00000XOther Service ProvidersPeer SpecialistGroup - Single Specialty