MEDICARE: ANDREA LEA LOPEZ CRNP

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	SP019985	PA
2	363LG0600X	Gerontology Nurse Practitioner	SP019985	PA
3	363LA2200X	Adult Health Nurse Practitioner	SP019985	PA

General Provider Information

NPI Number	:	1376104612
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDREA LEA LOPEZ CRNP

Provider Business Mailing Address
First Line	:	10 WYNNEWOOD AVE
Second Line	:
City	:	SINKING SPRING
State	:	PA
Zip	:	19608-1344
Country	:	US
Telephone Number	:	610-505-7311
Fax Number	:

Provider Business Practice Location Address
First Line	:	10 WYNNEWOOD AVE
Second Line	:
City	:	SINKING SPRING
State	:	PA
Zip	:	19608-1344
Country	:	US
Telephone Number	:	610-505-7311
Fax Number	:

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

Provider Enumeration Date	:	06/26/2019
Last Update Date	:	09/15/2022

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