Provider Demographics
NPI:1497563373
Name:LOPEZ, ROSE MARE (REGISTERED NURSE)
Entity type:Individual
Prefix:
First Name:ROSE
Middle Name:MARE
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6110 S 253RD PL APT S103
Mailing Address - Street 2:
Mailing Address - City:KENT
Mailing Address - State:WA
Mailing Address - Zip Code:98032-2231
Mailing Address - Country:US
Mailing Address - Phone:206-734-1641
Mailing Address - Fax:
Practice Address - Street 1:6110 S 253RD PL APT S103
Practice Address - Street 2:
Practice Address - City:KENT
Practice Address - State:WA
Practice Address - Zip Code:98032-2231
Practice Address - Country:US
Practice Address - Phone:206-734-1641
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-23
Last Update Date:2024-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN61260828163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health