MEDICARE: MICHELLE LOPEZ COMMUNITY HEALTH WOR

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	172V00000X	Community Health Worker		RI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1184353765
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHELLE LOPEZ COMMUNITY HEALTH WOR

Provider Business Mailing Address
First Line	:	171 SERVICE AVE
Second Line	:
City	:	WARWICK
State	:	RI
Zip	:	02886-1014
Country	:	US
Telephone Number	:	401-222-9157
Fax Number	:

Provider Business Practice Location Address
First Line	:	171 SERVICE AVE
Second Line	:
City	:	WARWICK
State	:	RI
Zip	:	02886-1014
Country	:	US
Telephone Number	:	401-222-9157
Fax Number	:

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

Provider Enumeration Date	:	06/08/2022
Last Update Date	:	06/08/2022

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