Healthcare Provider Details

I. General information

NPI: 1831478874
Provider Name (Legal Business Name): ELENA LOPEZ-BOWLAN APN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/09/2011
Last Update Date: 08/09/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6580 S MCCARRAN BLVD STE A
RENO NV
89509-6140
US

IV. Provider business mailing address

6580 S MCCARRAN BLVD STE A
RENO NV
89509-6140
US

V. Phone/Fax

Practice location:
  • Phone: 775-828-5100
  • Fax:
Mailing address:
  • Phone: 775-828-5100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberNVAPN480
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: