Healthcare Provider Details

I. General information

NPI: 1215755996
Provider Name (Legal Business Name): MARIE E LOPEZ FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/01/2024
Last Update Date: 10/24/2025
Certification Date: 10/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 GEM AVE
EGG HARBOR TOWNSHIP NJ
08234-9600
US

IV. Provider business mailing address

3 GEM AVE
EGG HARBOR TOWNSHIP NJ
08234-9600
US

V. Phone/Fax

Practice location:
  • Phone: 609-892-4229
  • Fax: 609-450-7058
Mailing address:
  • Phone: 609-892-4229
  • Fax: 609-450-7058

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number26NJ15164200
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: