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General NPI Number Information
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NPI Number | 1669026662
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Entity Type | Individual
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Provider Name | WILIANA E LOPEZ
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Gender | Female
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Dates
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Enumeration Date | 07/29/2019
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Last Update Date | 07/29/2019
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Provider Practice Location Address
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Address Line | 301 S MAIN ST
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City | FREEPORT
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State | NY
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Zip | 11520-5114
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Country | US
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Telephone | 631-968-3360
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Fax |
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Provider Business Mailing Address
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Address Line | 61 CENTRE ST
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City | FREEPORT
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State | NY
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Zip | 11520-3145
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Country | US
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Telephone | 516-543-7811
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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 | 344680
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License Number State | NY
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