Individual
BEATRICE R LOPEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP-C
Contact information
Practice address
1464 LINCOLNWAY S, LIGONIER, IN 46767-9601
(260) 894-7139
(260) 894-3171
Mailing address
11109 PARKVIEW PLAZA DR # 117, FORT WAYNE, IN 46845-1701
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
71002518A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000548946
ANTHEM
IN
05
—
200880510
—
IN
01
—
P00773342
MEDICARE RR
IN
Enumeration date
10/21/2007
Last updated
10/20/2022
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