Provider Demographics
NPI:1881475804
Name:LOPEZ-MOGENSEN, MARIA
Entity type:Individual
Prefix:MRS
First Name:MARIA
Middle Name:
Last Name:LOPEZ-MOGENSEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1222 CONCORD HUNT DR
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-8759
Mailing Address - Country:US
Mailing Address - Phone:615-410-8321
Mailing Address - Fax:
Practice Address - Street 1:1222 CONCORD HUNT DR
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:TN
Practice Address - Zip Code:37027-8759
Practice Address - Country:US
Practice Address - Phone:615-410-8321
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-06
Last Update Date:2023-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider