Provider Demographics
NPI:1770474843
Name:MESA LOPEZ, MILEYSI
Entity type:Individual
Prefix:
First Name:MILEYSI
Middle Name:
Last Name:MESA LOPEZ
Suffix:
Gender:X
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:307 CARDINAL DR
Mailing Address - Street 2:
Mailing Address - City:GRAND ISLAND
Mailing Address - State:NE
Mailing Address - Zip Code:68803-7001
Mailing Address - Country:US
Mailing Address - Phone:308-930-4013
Mailing Address - Fax:
Practice Address - Street 1:1017 W 5TH ST
Practice Address - Street 2:
Practice Address - City:HASTINGS
Practice Address - State:NE
Practice Address - Zip Code:68901-5046
Practice Address - Country:US
Practice Address - Phone:308-930-4013
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-15
Last Update Date:2025-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant