Provider Demographics
NPI:1063189330
Name:LOPEZ, VANESSA MARIE (MSN)
Entity type:Individual
Prefix:
First Name:VANESSA
Middle Name:MARIE
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:MSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3940 W HILLSDALE CT
Mailing Address - Street 2:
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93291-5538
Mailing Address - Country:US
Mailing Address - Phone:559-756-6759
Mailing Address - Fax:
Practice Address - Street 1:560 W GRANGEVILLE BLVD STE A
Practice Address - Street 2:
Practice Address - City:HANFORD
Practice Address - State:CA
Practice Address - Zip Code:93230-2858
Practice Address - Country:US
Practice Address - Phone:559-408-5533
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-25
Last Update Date:2021-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95018057363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily