Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2100X | Nurse Practitioner - Acute Care | 26NJ00936900 | NJ |
NPI | 1003460262 |
---|---|
Provider Name | Susan A Lopez |
First Address | Mantoloking, NJ 08738-1030 |
Second Address | Brick, NJ 08724-2373 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/07/2019 |
Last Update Date | 26/07/2019 |