Healthcare Provider Details

I. General information

NPI: 1295825289
Provider Name (Legal Business Name): MARY JANE LOPEZ MONTANO R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/13/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

US ARMY HEALTH CLINIC SCHWEINFURT CMR 457
APO AE
09033
DE

IV. Provider business mailing address

CMR 464 BOX 2975
APO AE
09226
DE

V. Phone/Fax

Practice location:
  • Phone: 0114997214763439
  • Fax: 0114997216872
Mailing address:
  • Phone: 097214763439
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP2201X
TaxonomyAmbulatory Care Registered Nurse
License Number172933
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: