Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2200X | Nurse Practitioner - Adult Health | RN056928 | GA |
NPI | 1023369477 |
---|---|
Provider Name | Melanie Becker Lopez |
First Address | Lawrenceville, GA 30043-5945 |
Second Address | Lawrenceville, GA 30043-5945 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/09/2012 |
Last Update Date | 25/09/2012 |