Individual
MARISSA ANN LOPEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
500 W VOTAW ST STE A, PORTLAND, IN 47371-1322
(260) 726-4350
(260) 726-9340
Mailing address
240 N TILLOTSON AVE, MUNCIE, IN 47304-3988
(765) 288-1928
(765) 741-0335
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
28212155A
IN
363LF0000X
Family Nurse Practitioner
Primary
71012622A
IN
Other
Enumeration date
04/28/2022
Last updated
06/28/2022
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