Provider Demographics
NPI:1033341151
Name:LOVINGSHIMER, VICKI LYNNE (LPN)
Entity Type:Individual
Prefix:MRS
First Name:VICKI
Middle Name:LYNNE
Last Name:LOVINGSHIMER
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 397
Mailing Address - Street 2:
Mailing Address - City:DUNCAN FALLS
Mailing Address - State:OH
Mailing Address - Zip Code:43734-0397
Mailing Address - Country:US
Mailing Address - Phone:740-303-3014
Mailing Address - Fax:
Practice Address - Street 1:306 ELM STREET
Practice Address - Street 2:
Practice Address - City:DUNCAN FALLS
Practice Address - State:OH
Practice Address - Zip Code:43734-0397
Practice Address - Country:US
Practice Address - Phone:740-303-3014
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-24
Last Update Date:2009-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN094458164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH5040ABCDMedicaid