Provider Demographics
NPI:1053899146
Name:LOPEZ, LAURA GABRIELA (LVN)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:GABRIELA
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20119 GRAMOND HALL DR
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77379-3353
Mailing Address - Country:US
Mailing Address - Phone:281-231-4937
Mailing Address - Fax:
Practice Address - Street 1:11929 UNIVERSITY BLVD STE 2M
Practice Address - Street 2:
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77479-4757
Practice Address - Country:US
Practice Address - Phone:281-238-8775
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-01
Last Update Date:2018-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX302605164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse