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General NPI Number Information
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NPI Number | 1497397707
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Entity Type | Individual
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Provider Name | MELISSA CARYN LOPEZ NP
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Gender | Female
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Dates
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Enumeration Date | 10/09/2019
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Last Update Date | 09/13/2024
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Provider Practice Location Address
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Address Line | 700 MYRTLE WAY
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City | JANESVILLE
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State | WI
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Zip | 53545-9111
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Country | US
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Telephone | 815-608-4673
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Fax |
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Provider Business Mailing Address
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Address Line | 700 MYRTLE WAY
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City | JANESVILLE
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State | WI
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Zip | 53545-9111
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Country | US
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Telephone | 815-608-4673
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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 | 041355297
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License Number State | IL
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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 | 1060933
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License Number State | WI
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