Healthcare Provider Details

I. General information

NPI: 1477472355
Provider Name (Legal Business Name): GLORIA JANET LOPEZ MCKOY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/14/2026
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

539 CANDIA RD
MANCHESTER NH
03109-4708
US

IV. Provider business mailing address

539 CANDIA RD
MANCHESTER NH
03109-4708
US

V. Phone/Fax

Practice location:
  • Phone: 603-661-3228
  • Fax:
Mailing address:
  • Phone: 603-661-3228
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License NumberNHL16441840
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: