Healthcare Provider Details

I. General information

NPI: 1770428195
Provider Name (Legal Business Name): MS. AMANDA LYNN LOPEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMANDA LYNN HOOVER

II. Dates (important events)

Enumeration Date: 04/22/2026
Last Update Date: 06/04/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 ATWELL RD
COOPERSTOWN NY
13326-1301
US

IV. Provider business mailing address

334 OTSEGO ST
ILION NY
13357-2512
US

V. Phone/Fax

Practice location:
  • Phone: 607-547-3456
  • Fax:
Mailing address:
  • Phone: 315-272-7475
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number359963
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: