Basic Information
| Provider Information | |||||||||
| NPI: | 1861912685 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LOPEZ | ||||||||
| FirstName: | JESSICA | ||||||||
| MiddleName: | MARIA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9710 STATE AVE | ||||||||
| Address2: | |||||||||
| City: | MARYSVILLE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 982702232 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3606531742 | ||||||||
| FaxNumber: | 3606577910 | ||||||||
| Practice Location | |||||||||
| Address1: | 9710 STATE AVE | ||||||||
| Address2: | |||||||||
| City: | MARYSVILLE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 982702232 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3606531742 | ||||||||
| FaxNumber: | 3606577910 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/22/2017 | ||||||||
| LastUpdateDate: | 06/24/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WM0102X | RN00175784 | WA | N | Nursing Service Providers | Registered Nurse | Maternal Newborn | 171M00000X | N | Other Service Providers | Case Manager/Care Coordinator | 163WC1500X | RN00175784 | WA | Y | Nursing Service Providers | Registered Nurse | Community Health |
No ID Information.