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Individual

CHARISSA ANYEL LOPEZ

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PMHNP

Contact information

Practice address
1255 W BASELINE RD STE 138, MESA, AZ 85202-5821
(480) 820-5422
(480) 775-4938
Mailing address
1255 W BASELINE RD STE 138, MESA, AZ 85202-5821
(480) 820-5422
(480) 775-4938

Taxonomy

Speciality
Code
Description
License number
State
163WP0808X
Psychiatric/Mental Health Registered Nurse
Primary
AP7463
AZ

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
PENDING
AZ
Enumeration date
11/21/2014
Last updated
11/21/2014
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