Provider Demographics
NPI:1326865767
Name:LOPEZ, DESTINEY MARIE
Entity type:Individual
Prefix:
First Name:DESTINEY
Middle Name:MARIE
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:DESTINEY
Other - Middle Name:MARIE
Other - Last Name:CURTIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:824 10TH AVE
Mailing Address - Street 2:
Mailing Address - City:NEBRASKA CITY
Mailing Address - State:NE
Mailing Address - Zip Code:68410-1370
Mailing Address - Country:US
Mailing Address - Phone:402-873-5513
Mailing Address - Fax:
Practice Address - Street 1:824 10TH AVE
Practice Address - Street 2:
Practice Address - City:NEBRASKA CITY
Practice Address - State:NE
Practice Address - Zip Code:68410-1370
Practice Address - Country:US
Practice Address - Phone:402-873-5513
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-25
Last Update Date:2024-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker