Healthcare Provider Details

I. General information

NPI: 1023905684
Provider Name (Legal Business Name): AWILDA LOPEZ RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2025
Last Update Date: 06/18/2025
Certification Date: 06/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

332 BIRNIE AVE
SPRINGFIELD MA
01107-1106
US

IV. Provider business mailing address

332 BIRNIE AVE
SPRINGFIELD MA
01107-1106
US

V. Phone/Fax

Practice location:
  • Phone: 413-439-2189
  • Fax: 413-451-0037
Mailing address:
  • Phone: 413-439-2189
  • Fax: 413-451-0037

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN282907
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: