Healthcare Provider Details

I. General information

NPI: 1346880275
Provider Name (Legal Business Name): ERICA LOPEZ FNP, RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ERICA LOCKLUND RN

II. Dates (important events)

Enumeration Date: 01/08/2020
Last Update Date: 01/08/2020
Certification Date: 01/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2003 W FULTON ST # 303
CHICAGO IL
60612-2345
US

IV. Provider business mailing address

2003 W FULTON ST # 303
CHICAGO IL
60612-2345
US

V. Phone/Fax

Practice location:
  • Phone: 312-243-2223
  • Fax:
Mailing address:
  • Phone: 312-243-2223
  • Fax: 312-243-2227

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209.019921
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: