MEDICARE: LOVELY LOUISSAINT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	891111	NY

General Provider Information

NPI Number	:	1396522538
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LOVELY LOUISSAINT

Provider Business Mailing Address
First Line	:	1473 E 104TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11236-4515
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1473 E 104TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11236-4515
Country	:	US
Telephone Number	:	347-422-2454
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/12/2023
Last Update Date	:	09/12/2023

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Directions to “ LOVELY LOUISSAINT ” Practice Location

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