Provider Demographics
NPI:1225623267
Name:HOLLIS, LOVVET (MSN, RN, PHN)
Entity Type:Individual
Prefix:
First Name:LOVVET
Middle Name:
Last Name:HOLLIS
Suffix:
Gender:F
Credentials:MSN, RN, PHN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:628 DAISY AVE APT 403
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90802-1163
Mailing Address - Country:US
Mailing Address - Phone:323-892-6182
Mailing Address - Fax:
Practice Address - Street 1:2525 GRAND AVE
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90815-1765
Practice Address - Country:US
Practice Address - Phone:562-570-4281
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-02
Last Update Date:2021-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA834731163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management