Provider Demographics
NPI:1194985085
Name:LOPEZ, CAROLYN ANN (RN)
Entity type:Individual
Prefix:
First Name:CAROLYN
Middle Name:ANN
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:95 FRANKLIN ST
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14202-3925
Mailing Address - Country:US
Mailing Address - Phone:716-858-7687
Mailing Address - Fax:716-858-4962
Practice Address - Street 1:95 FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14202-3925
Practice Address - Country:US
Practice Address - Phone:716-858-7687
Practice Address - Fax:716-858-4962
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-13
Last Update Date:2008-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY295748-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse