Provider Demographics
NPI:1295321230
Name:LOPEZ, DORA VENESSA I (FNP)
Entity type:Individual
Prefix:MS
First Name:DORA
Middle Name:VENESSA
Last Name:LOPEZ
Suffix:I
Gender:F
Credentials:FNP
Other - Prefix:MS
Other - First Name:DORA
Other - Middle Name:VENESSA
Other - Last Name:GARCIA
Other - Suffix:I
Other - Last Name Type:Former Name
Other - Credentials:RN/FNP
Mailing Address - Street 1:14470 HORIZON BLVD
Mailing Address - Street 2:
Mailing Address - City:HORIZON CITY
Mailing Address - State:TX
Mailing Address - Zip Code:79928-7695
Mailing Address - Country:US
Mailing Address - Phone:915-852-3225
Mailing Address - Fax:
Practice Address - Street 1:14470 HORIZON BLVD
Practice Address - Street 2:
Practice Address - City:HORIZON CITY
Practice Address - State:TX
Practice Address - Zip Code:79928-7695
Practice Address - Country:US
Practice Address - Phone:915-852-3225
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-14
Last Update Date:2020-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF11200601363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care