Healthcare Provider Details

I. General information

NPI: 1558206052
Provider Name (Legal Business Name): LAURA MELISSA QUEZADA LOPEZ PLMHP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/21/2026
Last Update Date: 06/12/2026
Certification Date: 06/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5074 AMES AVE
OMAHA NE
68104-2323
US

IV. Provider business mailing address

5074 AMES AVE
OMAHA NE
68104-2323
US

V. Phone/Fax

Practice location:
  • Phone: 531-355-3025
  • Fax: 531-355-7150
Mailing address:
  • Phone: 531-355-3025
  • Fax: 531-355-7150

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number14971
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: