Provider Demographics
NPI:1366164147
Name:LOPEZ, CHRISTINE (RN)
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9686 W OBERLIN WAY
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85383-8750
Mailing Address - Country:US
Mailing Address - Phone:708-714-2383
Mailing Address - Fax:
Practice Address - Street 1:9242 W UNION HILLS DR STE 102
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85382-8219
Practice Address - Country:US
Practice Address - Phone:602-884-6007
Practice Address - Fax:844-888-1174
Is Sole Proprietor?:No
Enumeration Date:2022-09-19
Last Update Date:2022-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ228501163WH0200X
IL041343455163WH0200X
AZHHA11908251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health