MEDICARE: JENNIFER THUY VI LOPEZ FNP-BC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP2300X	Primary Care Nurse Practitioner	1045614	TX
2	363LF0000X	Family Nurse Practitioner	1045614	TX

General Provider Information

NPI Number	:	1093384943
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER THUY VI LOPEZ FNP-BC

Provider Business Mailing Address
First Line	:	118 FLINT ROCK CT
Second Line	:
City	:	VICTORIA
State	:	TX
Zip	:	77904-2957
Country	:	US
Telephone Number	:	317-225-3657
Fax Number	:

Provider Business Practice Location Address
First Line	:	605 E SAN ANTONIO ST STE 510E
Second Line	:
City	:	VICTORIA
State	:	TX
Zip	:	77901-6011
Country	:	US
Telephone Number	:	361-576-9342
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/23/2021
Last Update Date	:	04/22/2022

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