Provider Demographics
NPI:1982445383
Name:LOPEZ, MIGUEL ERNESTO (FNP-C)
Entity type:Individual
Prefix:MR
First Name:MIGUEL
Middle Name:ERNESTO
Last Name:LOPEZ
Suffix:
Gender:M
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3433 W SIERRA VISTA DR
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85017-1446
Mailing Address - Country:US
Mailing Address - Phone:520-548-8050
Mailing Address - Fax:
Practice Address - Street 1:3433 W SIERRA VISTA DR
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85017-1446
Practice Address - Country:US
Practice Address - Phone:520-548-8050
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-03
Last Update Date:2024-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ308950363LF0000X
AZRN154332163WE0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WE0003XNursing Service ProvidersRegistered NurseEmergency