Provider Demographics
NPI:1134676729
Name:LOVELESS, BILLIE JO
Entity Type:Individual
Prefix:
First Name:BILLIE JO
Middle Name:
Last Name:LOVELESS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 E CLINTON ST
Mailing Address - Street 2:APT 1
Mailing Address - City:JOHNSTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:12095-2527
Mailing Address - Country:US
Mailing Address - Phone:518-848-3325
Mailing Address - Fax:
Practice Address - Street 1:6 EAST CLINTON STREET
Practice Address - Street 2:APT 1
Practice Address - City:JOHNSTOWN
Practice Address - State:NY
Practice Address - Zip Code:12095
Practice Address - Country:US
Practice Address - Phone:518-848-3325
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-01
Last Update Date:2016-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY274717-1273Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273Y00000XHospital UnitsRehabilitation Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY274717-1OtherLPN