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General NPI Number Information
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NPI Number | 1326558545
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Entity Type | Individual
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Provider Name | ELLYSE LOPEZ LAMONT FNP-C
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Gender | Female
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Dates
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Enumeration Date | 10/02/2017
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Last Update Date | 05/17/2023
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Provider Practice Location Address
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Address Line | 186 EASTERN BLVD N
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City | HAGERSTOWN
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State | MD
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Zip | 21740-5843
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Country | US
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Telephone | 301-302-7837
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Fax |
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Provider Business Mailing Address
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Address Line | 203 CHARTERHOUSE ST
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City | FALLING WATERS
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State | WV
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Zip | 25419-1698
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Country | US
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Telephone | 240-818-7400
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | AP135273
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | AP135273
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | R131456
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License Number State | MD
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