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General NPI Number Information
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NPI Number | 1326496597
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Entity Type | Individual
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Provider Name | JENNIFER LEANNE LOPEZ
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Gender | Female
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Dates
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Enumeration Date | 05/29/2016
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Last Update Date | 11/28/2016
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Provider Practice Location Address
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Address Line | 12010 S WARNER ELLIOT LOOP
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City | PHOENIX
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State | AZ
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Zip | 85044-2731
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Country | US
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Telephone | 480-961-2366
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 9415
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City | CHANDLER HEIGHTS
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State | AZ
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Zip | 85127-9415
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Country | US
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Telephone | 480-532-8241
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | RN120668
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License Number State | AZ
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