Healthcare Provider Details

I. General information

NPI: 1386527042
Provider Name (Legal Business Name): EMILY GRACE LOPEZ RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: EMILY GRACE MILLER RN

II. Dates (important events)

Enumeration Date: 07/30/2025
Last Update Date: 07/30/2025
Certification Date: 07/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9197 GRANT ST STE 200
THORNTON CO
80229-4337
US

IV. Provider business mailing address

1259 S FLOWER CIR APT E
LAKEWOOD CO
80232-2029
US

V. Phone/Fax

Practice location:
  • Phone: 303-450-3690
  • Fax:
Mailing address:
  • Phone: 720-454-2232
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN.1675666
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: