Healthcare Provider Details

I. General information

NPI: 1083171706
Provider Name (Legal Business Name): NATALIE LOVATO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/28/2019
Last Update Date: 02/28/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 E AZTEC AVE
GALLUP NM
87301-5509
US

IV. Provider business mailing address

1000 E AZTEC AVE
GALLUP NM
87301-5509
US

V. Phone/Fax

Practice location:
  • Phone: 505-721-1808
  • Fax: 505-721-1899
Mailing address:
  • Phone: 505-721-1808
  • Fax: 505-721-1899

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR54566
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: