Provider Demographics
NPI:1154503258
Name:LOVELACE, IRETTA HOWERTON
Entity Type:Individual
Prefix:MS
First Name:IRETTA
Middle Name:HOWERTON
Last Name:LOVELACE
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:IRETTA
Other - Middle Name:HOWERTON
Other - Last Name:LOVELACE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPN
Mailing Address - Street 1:1A FLINT AVE
Mailing Address - Street 2:
Mailing Address - City:HEMPSTEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11550-7107
Mailing Address - Country:US
Mailing Address - Phone:516-292-7907
Mailing Address - Fax:
Practice Address - Street 1:1A FLINT AVE
Practice Address - Street 2:
Practice Address - City:HEMPSTEAD
Practice Address - State:NY
Practice Address - Zip Code:11550-7107
Practice Address - Country:US
Practice Address - Phone:516-292-7907
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-29
Last Update Date:2007-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2097531164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse