Provider Demographics
NPI:1386232114
Name:THOMAS, LOVELY (RN)
Entity Type:Individual
Prefix:
First Name:LOVELY
Middle Name:
Last Name:THOMAS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:345 EDGERTON BLVD APT 101
Mailing Address - Street 2:
Mailing Address - City:AVENEL
Mailing Address - State:NJ
Mailing Address - Zip Code:07001-2246
Mailing Address - Country:US
Mailing Address - Phone:929-462-7723
Mailing Address - Fax:
Practice Address - Street 1:345 EDGERTON BLVD APT 101
Practice Address - Street 2:
Practice Address - City:AVENEL
Practice Address - State:NJ
Practice Address - Zip Code:07001-2246
Practice Address - Country:US
Practice Address - Phone:929-462-7723
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-07
Last Update Date:2021-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NR21941400163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJCHB981333300Medicaid