Healthcare Provider Details

I. General information

NPI: 1275942690
Provider Name (Legal Business Name): JENNIFER KATE LOVALLO PNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2014
Last Update Date: 09/22/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3590 SILVER LAKE ROAD
TRAVERSE CITY MI
49684
US

IV. Provider business mailing address

3590 SILVER LAKE ROAD
TRAVERSE CITY MI
49684
US

V. Phone/Fax

Practice location:
  • Phone: 231-642-5291
  • Fax:
Mailing address:
  • Phone: 231-642-5291
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number4704416176
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number382479
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: