Healthcare Provider Details

I. General information

NPI: 1275454886
Provider Name (Legal Business Name): JANELLE LOPEZ MASTERS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/22/2026
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1899 BILLINGSGATE CIR STE C
HENRICO VA
23238-4243
US

IV. Provider business mailing address

6021 COUNTRY WALK RD
MIDLOTHIAN VA
23112-2249
US

V. Phone/Fax

Practice location:
  • Phone: 804-928-5830
  • Fax:
Mailing address:
  • Phone: 804-928-5830
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number0024198042
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: