Healthcare Provider Details

I. General information

NPI: 1467478982
Provider Name (Legal Business Name): LILIANA LOPEZ MSN, FNP, DNPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/15/2006
Last Update Date: 08/03/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 S MAIN ST STE E
SPRING VALLEY NY
10977-4917
US

IV. Provider business mailing address

25 S MAIN ST SUITE E
SPRING VALLEY NY
10977-4917
US

V. Phone/Fax

Practice location:
  • Phone: 845-499-5496
  • Fax: 845-290-1435
Mailing address:
  • Phone: 845-499-5496
  • Fax: 845-290-1435

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF334480-1
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number450396
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: