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General NPI Number Information
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NPI Number | 1821658378
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Entity Type | Individual
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Provider Name | CAITLIN LOPEZ NP
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Gender | Female
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Dates
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Enumeration Date | 06/17/2019
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Last Update Date | 06/17/2019
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Provider Practice Location Address
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Address Line | 2211 FORT ST
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City | WYANDOTTE
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State | MI
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Zip | 48192-4135
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Country | US
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Telephone | 734-357-0505
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Fax |
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Provider Business Mailing Address
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Address Line | 28150 ROSE AVE
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City | BROWNSTOWN TWP
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State | MI
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Zip | 48183-4833
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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 | 4704301757
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License Number State | MI
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