Healthcare Provider Details

I. General information

NPI: 1952784605
Provider Name (Legal Business Name): MONICA C LOPEZ FPA-APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2015
Last Update Date: 02/03/2025
Certification Date: 02/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4840 W BYRON ST
CHICAGO IL
60641-2712
US

IV. Provider business mailing address

4840 W BYRON ST
CHICAGO IL
60641-2712
US

V. Phone/Fax

Practice location:
  • Phone: 773-282-7800
  • Fax:
Mailing address:
  • Phone: 773-282-8000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number277.003682
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number277.003682
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: