Individual
MELISSA CARYN LOPEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
700 MYRTLE WAY, JANESVILLE, WI 53545-9111
(815) 608-4673
Mailing address
700 MYRTLE WAY, JANESVILLE, WI 53545-9111
(815) 608-4673
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
041355297
IL
363LF0000X
Family Nurse Practitioner
Primary
1060933
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1235125717
GRP NPI
IL
Enumeration date
10/09/2019
Last updated
09/13/2024
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