MEDICARE: MRS. MARYANN LOPEZ NP

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	363LF0000X	Family Nurse Practitioner	332491	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1649386186
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MARYANN LOPEZ NP

Provider Business Mailing Address
First Line	:	745 64TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11220-4745
Country	:	US
Telephone Number	:	718-765-2576
Fax Number	:	718-635-5962

Provider Business Practice Location Address
First Line	:	745 64TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11220-4745
Country	:	US
Telephone Number	:	718-765-2576
Fax Number	:	718-635-5962

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

Provider Enumeration Date	:	08/21/2006
Last Update Date	:	07/26/2022

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