Provider Demographics
NPI:1306322862
Name:LOPEZ, AGNES (DNP, FNP)
Entity type:Individual
Prefix:
First Name:AGNES
Middle Name:
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:DNP, FNP
Other - Prefix:
Other - First Name:AGNES
Other - Middle Name:
Other - Last Name:RODRIGUES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DNP, FNP
Mailing Address - Street 1:3020 S UNION AVE
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98409-3317
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3020 S UNION AVE
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98409-3317
Practice Address - Country:US
Practice Address - Phone:253-922-4018
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-17
Last Update Date:2023-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN61438946163W00000X
CA95152450163W00000X
CA95022466363LF0000X
WAAP61439019363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse