Healthcare Provider Details

I. General information

NPI: 1396373551
Provider Name (Legal Business Name): NICOLE LOUISE LOPEZ FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2020
Last Update Date: 02/04/2025
Certification Date: 02/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8437 KENNEDY AVE
HIGHLAND IN
46322-1140
US

IV. Provider business mailing address

PO BOX 365
SCHERERVILLE IN
46375-0365
US

V. Phone/Fax

Practice location:
  • Phone: 219-237-2079
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberF02200607
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF02200607
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: