MEDICARE: JACQUELINE LOPEZ CPM

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	176B00000X	Midwife		MT

General Provider Information

NPI Number	:	1407356900
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACQUELINE LOPEZ CPM

Provider Business Mailing Address
First Line	:	1406 16TH AVE SW
Second Line	:
City	:	GREAT FALLS
State	:	MT
Zip	:	59404-3134
Country	:	US
Telephone Number	:	406-606-3510
Fax Number	:	406-578-3135

Provider Business Practice Location Address
First Line	:	1406 16TH AVE SW
Second Line	:
City	:	GREAT FALLS
State	:	MT
Zip	:	59404-3134
Country	:	US
Telephone Number	:	406-606-3510
Fax Number	:	406-578-3135

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

Provider Enumeration Date	:	02/20/2018
Last Update Date	:	04/24/2024

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Directions to “ JACQUELINE LOPEZ CPM” Practice Location

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