Provider Demographics
NPI:1275979510
Name:ANDERSON, LOVEJOY M (LPN)
Entity Type:Individual
Prefix:
First Name:LOVEJOY
Middle Name:M
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1013 RENFIELD RD
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44121-2415
Mailing Address - Country:US
Mailing Address - Phone:216-744-0421
Mailing Address - Fax:
Practice Address - Street 1:1013 RENFIELD RD
Practice Address - Street 2:
Practice Address - City:CLEVELAND HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44121-2415
Practice Address - Country:US
Practice Address - Phone:216-744-0421
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-14
Last Update Date:2013-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH152762164W00000X
OHPN 152762164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse