Provider Demographics
NPI:1043913460
Name:LOVELACE, JONATHAN EDWARDS (RN)
Entity Type:Individual
Prefix:MR
First Name:JONATHAN
Middle Name:EDWARDS
Last Name:LOVELACE
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 TARRS LN W
Mailing Address - Street 2:
Mailing Address - City:ROCKPORT
Mailing Address - State:MA
Mailing Address - Zip Code:01966-2051
Mailing Address - Country:US
Mailing Address - Phone:978-879-8284
Mailing Address - Fax:
Practice Address - Street 1:8 TARRS LN W
Practice Address - Street 2:
Practice Address - City:ROCKPORT
Practice Address - State:MA
Practice Address - Zip Code:01966-2051
Practice Address - Country:US
Practice Address - Phone:978-879-8284
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-24
Last Update Date:2023-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2289947163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse