Healthcare Provider Details

I. General information

NPI: 1790168870
Provider Name (Legal Business Name): NICHOLAS EDWARD LOPER MSN, AGACNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/07/2015
Last Update Date: 06/24/2021
Certification Date: 06/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4860 Y ST STE 3740
SACRAMENTO CA
95817-2307
US

IV. Provider business mailing address

1780 CREEKSIDE DR APT 1927
FOLSOM CA
95630-3860
US

V. Phone/Fax

Practice location:
  • Phone: 916-734-3658
  • Fax:
Mailing address:
  • Phone: 909-648-0055
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number767564
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number95003072
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: