Provider Demographics
NPI:1023347853
Name:LOPEZ, JESSENIA (LPN)
Entity type:Individual
Prefix:MRS
First Name:JESSENIA
Middle Name:
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 W 91ST ST
Mailing Address - Street 2:APT 2G
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10024-1306
Mailing Address - Country:US
Mailing Address - Phone:626-287-1975
Mailing Address - Fax:718-927-9398
Practice Address - Street 1:120 W 91ST ST
Practice Address - Street 2:APT 2G
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10024-1306
Practice Address - Country:US
Practice Address - Phone:626-287-1975
Practice Address - Fax:718-927-9398
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-07
Last Update Date:2010-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY298721164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse