Provider Demographics
NPI:1467070995
Name:LOVETT, DALLIE (RN)
Entity Type:Individual
Prefix:
First Name:DALLIE
Middle Name:
Last Name:LOVETT
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 1:110742 S 4200 RD
Mailing Address - Street 2:
Mailing Address - City:CHECOTAH
Mailing Address - State:OK
Mailing Address - Zip Code:74426-3035
Mailing Address - Country:US
Mailing Address - Phone:918-617-7478
Mailing Address - Fax:
Practice Address - Street 1:500 EUNICE BURNS RD
Practice Address - Street 2:
Practice Address - City:EUFAULA
Practice Address - State:OK
Practice Address - Zip Code:74432-4052
Practice Address - Country:US
Practice Address - Phone:918-689-2540
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-10
Last Update Date:2020-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKR0125555163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse