Provider Demographics
NPI:1861912685
Name:LOPEZ, JESSICA MARIA
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:MARIA
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9710 STATE AVE
Mailing Address - Street 2:
Mailing Address - City:MARYSVILLE
Mailing Address - State:WA
Mailing Address - Zip Code:98270-2232
Mailing Address - Country:US
Mailing Address - Phone:360-653-1742
Mailing Address - Fax:360-657-7910
Practice Address - Street 1:9710 STATE AVE
Practice Address - Street 2:
Practice Address - City:MARYSVILLE
Practice Address - State:WA
Practice Address - Zip Code:98270-2232
Practice Address - Country:US
Practice Address - Phone:360-653-1742
Practice Address - Fax:360-657-7910
Is Sole Proprietor?:No
Enumeration Date:2017-06-22
Last Update Date:2019-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN00175784163WM0102X, 163WC1500X
171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health
No163WM0102XNursing Service ProvidersRegistered NurseMaternal Newborn
No171M00000XOther Service ProvidersCase Manager/Care Coordinator