Healthcare Provider Details

I. General information

NPI: 1336739499
Provider Name (Legal Business Name): STEPHANIE LYNN LOVITT RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/22/2021
Last Update Date: 01/22/2021
Certification Date: 01/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

650 HUEBNER RD ATTN: PRIMARY CARE
FORT RILEY KS
66442-4030
US

IV. Provider business mailing address

1919 APACHE DR
JUNCTION CITY KS
66441-9551
US

V. Phone/Fax

Practice location:
  • Phone: 785-240-8267
  • Fax:
Mailing address:
  • Phone: 785-717-9221
  • Fax: 630-570-5779

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number99324
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: