Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0000X | Nurse Practitioner - Neonatal | 0024117297 | VA |
NPI | 1114123064 |
---|---|
Provider Name | Martina H Lopez |
First Address | Fairfax, VA 22031 |
Second Address | Arlington, VA 22205-3610 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/06/2007 |
Last Update Date | 08/07/2007 |