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General NPI Number Information
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NPI Number | 1851034110
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Entity Type | Individual
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Provider Name | NICOLE MARIE LOPEZ MD
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Gender | Female
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Dates
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Enumeration Date | 04/15/2022
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Last Update Date | 07/07/2025
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Provider Practice Location Address
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Address Line | 301 FISHER ST
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City | KEESLER AFB
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State | MS
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Zip | 39534-2508
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Country | US
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Telephone | 228-376-2273
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Fax |
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Provider Business Mailing Address
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Address Line | 3165 SW 133RD PL
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City | MIAMI
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State | FL
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Zip | 33175-6653
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Country | US
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Telephone | 786-269-8043
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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 | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | 35.151039
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License Number State | OH
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