Healthcare Provider Details

I. General information

NPI: 1326103060
Provider Name (Legal Business Name): NANCY SHEPARD LOPEZ NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: NANCY ELIZABETH SHEPARD NP

II. Dates (important events)

Enumeration Date: 12/22/2006
Last Update Date: 08/10/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1825 4TH ST
SAN FRANCISCO CA
94143-2350
US

IV. Provider business mailing address

1825 4TH ST
SAN FRANCISCO CA
94143-2350
US

V. Phone/Fax

Practice location:
  • Phone: 415-885-7671
  • Fax: 415-353-9522
Mailing address:
  • Phone: 415-885-7671
  • Fax: 415-353-9522

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WX0200X
TaxonomyOncology Registered Nurse
License Number339311
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number14471
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: