Healthcare Provider Details

I. General information

NPI: 1396364766
Provider Name (Legal Business Name): ERICA PAIGE LOPEZ BSN, AGPCNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/15/2020
Last Update Date: 03/05/2024
Certification Date: 03/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 PARKER HILL AVE
BOSTON MA
02120-2847
US

IV. Provider business mailing address

69 SHERBURN CIR
WESTON MA
02493-1050
US

V. Phone/Fax

Practice location:
  • Phone: 617-754-5000
  • Fax:
Mailing address:
  • Phone: 781-801-4867
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License NumberRN2295701
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberRM2295701
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: