Provider Demographics
NPI:1205030673
Name:LOVRIN, MELLEN (DRNP)
Entity Type:Individual
Prefix:DR
First Name:MELLEN
Middle Name:
Last Name:LOVRIN
Suffix:
Gender:F
Credentials:DRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:85 NORTH BROADWAY
Mailing Address - Street 2:
Mailing Address - City:NYACK
Mailing Address - State:NY
Mailing Address - Zip Code:10960
Mailing Address - Country:US
Mailing Address - Phone:845-353-6780
Mailing Address - Fax:845-353-6780
Practice Address - Street 1:85 N BROADWAY
Practice Address - Street 2:
Practice Address - City:NYACK
Practice Address - State:NY
Practice Address - Zip Code:10960-2627
Practice Address - Country:US
Practice Address - Phone:845-353-6780
Practice Address - Fax:845-353-6780
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF400210363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health