| Doctor Name: | BEATRICE LOPEZ |
| NPI Number: | 1184813693 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | NP-C |
| License Number: | 71002518A |
| Business Practice Address: | 1464 Lincolnway S Ligonier, IN - 467679601 |
| Business Phone Number: | 2608947139 |
| Business Fax Number: | 2608943171 |
| Mailing Address: | 1234 E Dupont Rd, Suite 3 FORT WAYNE |
| State: | IN |
| Postal Code: | 468251545 |
| Phone Number: | 2603739965 |
| Fax Number: | 2604585664 |
| NPI Enumeration Date: | 10/21/2007 |
| NPI Last Update Date: | 01/07/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LA2200X |
| License Number: | 71002518A |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | IN |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Adult Health |
| Taxonomy Definition: | |