Provider Demographics
NPI:1952784605
Name:LOPEZ, MONICA C (FPA-APRN)
Entity type:Individual
Prefix:
First Name:MONICA
Middle Name:C
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:FPA-APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4840 W BYRON ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60641-2712
Mailing Address - Country:US
Mailing Address - Phone:773-282-8000
Mailing Address - Fax:
Practice Address - Street 1:4840 W BYRON ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60641-2712
Practice Address - Country:US
Practice Address - Phone:773-282-7800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-30
Last Update Date:2025-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL277.003682207QA0401X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1104658038Medicaid
IL13581910OtherCAQH