Healthcare Provider Details

I. General information

NPI: 1508774134
Provider Name (Legal Business Name): HEATHER LOPEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2026
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2028 2ND AVE NW
WEST FARGO ND
58078-1317
US

IV. Provider business mailing address

2028 2ND AVE NW
WEST FARGO ND
58078-1317
US

V. Phone/Fax

Practice location:
  • Phone: 701-356-2000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR40476
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: