Healthcare Provider Details

I. General information

NPI: 1497563373
Provider Name (Legal Business Name): ROSE MARE LOPEZ REGISTERED NURSE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/23/2024
Last Update Date: 12/23/2024
Certification Date: 12/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6110 S 253RD PL APT S103
KENT WA
98032-2231
US

IV. Provider business mailing address

6110 S 253RD PL APT S103
KENT WA
98032-2231
US

V. Phone/Fax

Practice location:
  • Phone: 206-734-1641
  • Fax:
Mailing address:
  • Phone: 206-734-1641
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License NumberRN61260828
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: