Healthcare Provider Details

I. General information

NPI: 1558662007
Provider Name (Legal Business Name): STEPHANIE J LOVETT CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/14/2010
Last Update Date: 01/24/2020
Certification Date: 01/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1020 TRUMP RD NW
CARROLLTON OH
44615-8422
US

IV. Provider business mailing address

1020 TRUMP RD NW
CARROLLTON OH
44615-8422
US

V. Phone/Fax

Practice location:
  • Phone: 330-627-0884
  • Fax: 330-627-0885
Mailing address:
  • Phone: 330-627-0884
  • Fax: 330-627-0885

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCOA 11564
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: