Healthcare Provider Details

I. General information

NPI: 1760617377
Provider Name (Legal Business Name): MARCIA L LOVETT RN, MN, APN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2009
Last Update Date: 11/03/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1725 W HARRISON ST SUITE 818
CHICAGO IL
60612-3841
US

IV. Provider business mailing address

1725 W HARRISON ST SUITE 818
CHICAGO IL
60612-3841
US

V. Phone/Fax

Practice location:
  • Phone: 312-942-5500
  • Fax: 312-563-2080
Mailing address:
  • Phone: 312-942-5500
  • Fax: 312-563-2080

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209001925
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: