MEDICARE: ERIKA DENISE LOPEZ NNP-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	163WN0002X	Neonatal Intensive Care Registered Nurse	815627	TX
2	363LN0000X	Neonatal Nurse Practitioner	1175515	TX

General Provider Information

NPI Number	:	1093559213
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERIKA DENISE LOPEZ NNP-BC

Provider Business Mailing Address
First Line	:	13207 EMERALD ISLE ST
Second Line	:
City	:	HORIZON CITY
State	:	TX
Zip	:	79928-2519
Country	:	US
Telephone Number	:	915-256-7132
Fax Number	:

Provider Business Practice Location Address
First Line	:	13207 EMERALD ISLE ST
Second Line	:
City	:	HORIZON CITY
State	:	TX
Zip	:	79928-2519
Country	:	US
Telephone Number	:	915-256-7132
Fax Number	:

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

Provider Enumeration Date	:	06/21/2024
Last Update Date	:	12/09/2024

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