Organization
GRACEFUL AGING LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. AMY ELISE LOPEZ DNP (OWNER)
(575) 621-3390
Entity
Organization
Contact information
Practice address
2707 SPITZ ST, LAS CRUCES, NM 88005-1338
(575) 203-1477
(575) 888-2444
Mailing address
PO BOX 13426, LAS CRUCES, NM 88013-3426
(575) 203-1477
(575) 888-2444
Taxonomy
Speciality
Code
Description
License number
State
163WW0000X
Wound Care Registered Nurse
—
—
246RP1900X
Phlebotomy Technician
—
—
363LA2200X
Adult Health Nurse Practitioner
—
—
363LG0600X
Gerontology Nurse Practitioner
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
12431265
—
NM
Enumeration date
12/27/2018
Last updated
03/09/2026
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