MEDICARE: OLIVIA LOPEZ

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LA2100X	Acute Care Nurse Practitioner	SP034678	PA

General Provider Information

NPI Number	:	1164387262
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	OLIVIA LOPEZ

Provider Business Mailing Address
First Line	:	3400 SPRUCE ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19104-4238
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3400 SPRUCE ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19104-4238
Country	:	US
Telephone Number	:	215-662-4000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/20/2025
Last Update Date	:	02/12/2026

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Directions to “ OLIVIA LOPEZ ” Practice Location

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