Provider Demographics
NPI:1366135378
Name:LOPEZ, ANGELICA RAYE (DNP, AGACNP-BC)
Entity type:Individual
Prefix:
First Name:ANGELICA
Middle Name:RAYE
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:DNP, AGACNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9520 W PALM LN STE 150
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85037-4454
Mailing Address - Country:US
Mailing Address - Phone:602-584-5444
Mailing Address - Fax:602-584-6202
Practice Address - Street 1:9520 W PALM LN STE 150
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85037-4454
Practice Address - Country:US
Practice Address - Phone:602-584-5444
Practice Address - Fax:602-584-6202
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-26
Last Update Date:2024-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ303772363LA2100X
AZRN212441163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care