Provider Demographics
NPI:1699457333
Name:LOPEZ, JADE (MSN, PMHNP-BC)
Entity type:Individual
Prefix:
First Name:JADE
Middle Name:
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:MSN, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9197 CASTLE VALLEY AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89178-7580
Mailing Address - Country:US
Mailing Address - Phone:702-601-6701
Mailing Address - Fax:
Practice Address - Street 1:9197 CASTLE VALLEY AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89178-7580
Practice Address - Country:US
Practice Address - Phone:702-601-6701
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-02
Last Update Date:2023-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV831918163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health