MEDICARE: CONSTANCE ELYSE LOPEZ FNP-C

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	207Q00000X	Family Medicine Physician	77189	NM

General Provider Information

NPI Number	:	1316717333
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CONSTANCE ELYSE LOPEZ FNP-C

Provider Business Mailing Address
First Line	:	10501 MONTGOMERY BLVD NE STE 320
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87111-3832
Country	:	US
Telephone Number	:	505-886-1010
Fax Number	:

Provider Business Practice Location Address
First Line	:	10501 MONTGOMERY BLVD NE STE 320
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87111-3832
Country	:	US
Telephone Number	:	505-886-1010
Fax Number	:

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

Provider Enumeration Date	:	01/02/2024
Last Update Date	:	12/15/2025

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