Healthcare Provider Details

I. General information

NPI: 1497477236
Provider Name (Legal Business Name): JOHANNA JOHANNI-LOPEZ NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/19/2022
Last Update Date: 06/04/2025
Certification Date: 06/04/2025
Deactivation Date: 05/14/2025
Reactivation Date: 06/03/2025

III. Provider practice location address

60 EAST ST
METHUEN MA
01844-4500
US

IV. Provider business mailing address

60 EAST ST
METHUEN MA
01844-4500
US

V. Phone/Fax

Practice location:
  • Phone: 978-683-9177
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN2261350
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: