Provider Demographics
NPI:1699293977
Name:LOPEZ, VITALIA (LPN)
Entity type:Individual
Prefix:
First Name:VITALIA
Middle Name:
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1064 FOX RUN
Mailing Address - Street 2:
Mailing Address - City:READING
Mailing Address - State:PA
Mailing Address - Zip Code:19606-1136
Mailing Address - Country:US
Mailing Address - Phone:610-679-4249
Mailing Address - Fax:
Practice Address - Street 1:1064 FOX RUN
Practice Address - Street 2:
Practice Address - City:READING
Practice Address - State:PA
Practice Address - Zip Code:19606
Practice Address - Country:US
Practice Address - Phone:610-679-4249
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-06
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPN284577164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse