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General NPI Number Information
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NPI Number | 1629893557
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Entity Type | Individual
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Provider Name | MARINA LOPEZ
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Gender | Female
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Dates
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Enumeration Date | 11/15/2024
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Last Update Date | 11/17/2024
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Provider Practice Location Address
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Address Line | 2620 RUBY VISTA DR
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City | ELKO
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State | NV
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Zip | 89801-1638
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Country | US
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Telephone | 775-753-7626
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Fax |
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Provider Business Mailing Address
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Address Line | 2620 RUBY VISTA DR
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City | ELKO
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State | NV
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Zip | 89801-1638
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Country | US
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Telephone |
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 810285
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License Number State | NV
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