Healthcare Provider Details

I. General information

NPI: 1750926689
Provider Name (Legal Business Name): LOVAN VANCLIN OLOKO-NELSON APN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/14/2019
Last Update Date: 01/08/2020
Certification Date: 01/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 MAIN AVE STE 1B
CLIFTON NJ
07011-2266
US

IV. Provider business mailing address

281 PATERSON AVE
PATERSON NJ
07502-1706
US

V. Phone/Fax

Practice location:
  • Phone: 973-689-6700
  • Fax: 973-689-6582
Mailing address:
  • Phone: 973-202-9466
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number26NJ00968800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: