Provider Demographics
NPI:1730955857
Name:LOPEZ, AMANDA MARIE (FNP-BC)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:MARIE
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9727 ELK GROVE FLORIN RD STE 120
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95624-2291
Mailing Address - Country:US
Mailing Address - Phone:575-635-0935
Mailing Address - Fax:
Practice Address - Street 1:9093 ELK GROVE BLVD STE 100
Practice Address - Street 2:
Practice Address - City:ELK GROVE
Practice Address - State:CA
Practice Address - Zip Code:95624-2047
Practice Address - Country:US
Practice Address - Phone:916-937-3094
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-29
Last Update Date:2025-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95028171363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily