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NPI Code Detail

MEDICARE: MELISSA LOPEZ-LICONA RN

MEDICARE: MELISSA LOPEZ-LICONA RN
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
1163W00000XRegistered NurseRN331273GA

General Provider Information

NPI Number : 1548129893
Entity Type Code : Individual
Provider Name (Legal Business Name) : MELISSA LOPEZ-LICONA RN
Provider Business Mailing Address
First Line : 1821 TRAVERS CIR
Second Line :
City : LAWRENCEVILLE
State : GA
Zip : 30044-4533
Country : US
Telephone Number : 404-918-6824
Fax Number :
Provider Business Practice Location Address
First Line : 1300 PEACHTREE INDUSTRIAL BLVD STE 4203
Second Line :
City : SUWANEE
State : GA
Zip : 30024-4540
Country : US
Telephone Number : 770-831-3018
Fax Number : 770-831-3669
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/21/2026
Last Update Date : 01/21/2026

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