Provider Demographics
NPI:1801490909
Name:LOPEZ, ELAINA GABRIELLE (FNP-C)
Entity type:Individual
Prefix:
First Name:ELAINA
Middle Name:GABRIELLE
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:ELAINA
Other - Middle Name:GABRIELLE
Other - Last Name:PRYOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MAIDEN NAME
Mailing Address - Street 1:12460 BREAKLINES ST APT 406
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46032-7664
Mailing Address - Country:US
Mailing Address - Phone:317-481-1103
Mailing Address - Fax:
Practice Address - Street 1:333 S MADISON ST
Practice Address - Street 2:
Practice Address - City:MUNCIE
Practice Address - State:IN
Practice Address - Zip Code:47305-2465
Practice Address - Country:US
Practice Address - Phone:765-286-7000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-30
Last Update Date:2020-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71010620A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily