Provider Demographics
NPI:1811666795
Name:LOPEZ, SULY AIME (NP)
Entity type:Individual
Prefix:
First Name:SULY
Middle Name:AIME
Last Name:LOPEZ
Suffix:
Gender:
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16716 E PALISADES BLVD STE 101B
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN HILLS
Mailing Address - State:AZ
Mailing Address - Zip Code:85268-3846
Mailing Address - Country:US
Mailing Address - Phone:541-272-2333
Mailing Address - Fax:
Practice Address - Street 1:16716 E PALISADES BLVD STE 101B
Practice Address - Street 2:
Practice Address - City:FOUNTAIN HILLS
Practice Address - State:AZ
Practice Address - Zip Code:85268-3846
Practice Address - Country:US
Practice Address - Phone:480-587-5738
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-13
Last Update Date:2025-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR202108976NP-PP363LF0000X
AZ307652363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily