Provider Demographics
NPI:1124741160
Name:LOPEZ, JAN BYRON (BSN RN)
Entity type:Individual
Prefix:
First Name:JAN
Middle Name:BYRON
Last Name:LOPEZ
Suffix:
Gender:M
Credentials:BSN RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21008 76TH AVE W
Mailing Address - Street 2:
Mailing Address - City:EDMONDS
Mailing Address - State:WA
Mailing Address - Zip Code:98026-7104
Mailing Address - Country:US
Mailing Address - Phone:425-778-0107
Mailing Address - Fax:425-670-4187
Practice Address - Street 1:21008 76TH AVE W
Practice Address - Street 2:
Practice Address - City:EDMONDS
Practice Address - State:WA
Practice Address - Zip Code:98026-7104
Practice Address - Country:US
Practice Address - Phone:425-778-0107
Practice Address - Fax:425-670-4187
Is Sole Proprietor?:No
Enumeration Date:2022-09-23
Last Update Date:2022-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN60710403163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse