Provider Demographics
NPI:1215564554
Name:LOVELY, CHRISTINA LOUISE (FNP)
Entity Type:Individual
Prefix:MRS
First Name:CHRISTINA
Middle Name:LOUISE
Last Name:LOVELY
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:MISS
Other - First Name:CHRISTINA
Other - Middle Name:L
Other - Last Name:KUBICEK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3813 HAVEN AVE
Mailing Address - Street 2:
Mailing Address - City:RACINE
Mailing Address - State:WI
Mailing Address - Zip Code:53405-2325
Mailing Address - Country:US
Mailing Address - Phone:262-939-2926
Mailing Address - Fax:
Practice Address - Street 1:3813 HAVEN AVE
Practice Address - Street 2:
Practice Address - City:RACINE
Practice Address - State:WI
Practice Address - Zip Code:53405-2325
Practice Address - Country:US
Practice Address - Phone:262-939-2926
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-26
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI9984-33363L00000X
WI9984363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner