Healthcare Provider Details

I. General information

NPI: 1942136197
Provider Name (Legal Business Name): TANYA LOPEZ RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/23/2026
Last Update Date: 06/23/2026
Certification Date: 06/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7979 N SHADELAND AVE
INDIANAPOLIS IN
46250-2042
US

IV. Provider business mailing address

7979 N SHADELAND AVE
INDIANAPOLIS IN
46250-2042
US

V. Phone/Fax

Practice location:
  • Phone: 317-355-4113
  • Fax:
Mailing address:
  • Phone: 317-355-4113
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WX0200X
TaxonomyOncology Registered Nurse
License Number28184661A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: