MEDICARE: DAISY MICHELLE 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	163WA0400X	Addiction (Substance Use Disorder) Registered Nurse	PN.0338887	CO

General Provider Information

NPI Number	:	1558157677
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAISY MICHELLE LOPEZ

Provider Business Mailing Address
First Line	:	3725 OWENS ST APT 4
Second Line	:
City	:	WHEAT RIDGE
State	:	CO
Zip	:	80033-5505
Country	:	US
Telephone Number	:	940-594-7930
Fax Number	:

Provider Business Practice Location Address
First Line	:	8790 W COLFAX AVE
Second Line	:
City	:	LAKEWOOD
State	:	CO
Zip	:	80215-4003
Country	:	US
Telephone Number	:	720-750-8137
Fax Number	:

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

Provider Enumeration Date	:	04/16/2025
Last Update Date	:	04/16/2025

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Directions to “ DAISY MICHELLE LOPEZ ” Practice Location

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