Healthcare Provider Details

I. General information

NPI: 1811827405
Provider Name (Legal Business Name): NANCY LOPEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/23/2026
Last Update Date: 05/23/2026
Certification Date: 05/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

245 E 149TH ST
BRONX NY
10451-5516
US

IV. Provider business mailing address

240 PENNYFIELD AVE
BRONX NY
10465-4079
US

V. Phone/Fax

Practice location:
  • Phone: 929-257-4459
  • Fax:
Mailing address:
  • Phone: 929-257-4459
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number779056
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: