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General NPI Number Information
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NPI Number | 1376701821
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Entity Type | Individual
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Provider Name | MARY G. LOPEZ NP
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Gender | Female
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Dates
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Enumeration Date | 05/30/2008
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Last Update Date | 05/30/2008
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Provider Practice Location Address
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Address Line | 554 LARKFIELD RD SUITE 105
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City | EAST NORTHPORT
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State | NY
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Zip | 11731-4205
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Country | US
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Telephone | 631-368-3800
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Fax | 631-368-3802
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Provider Business Mailing Address
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Address Line | 554 LARKFIELD RD SUITE 105
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City | EAST NORTHPORT
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State | NY
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Zip | 11731-4205
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Country | US
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Telephone | 631-368-3800
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Fax | 631-368-3802
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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 | 363LW0102X
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Taxonomy Name | Women's Health Nurse Practitioner
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License Number | F420526
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License Number State | NY
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