Provider Demographics
NPI:1467851899
Name:BIALOSE, LOVELYN I (FNP)
Entity Type:Individual
Prefix:
First Name:LOVELYN
Middle Name:I
Last Name:BIALOSE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 LAKE SHORE DR
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20721-2909
Mailing Address - Country:US
Mailing Address - Phone:202-817-0027
Mailing Address - Fax:
Practice Address - Street 1:9801 GREENBELT RD STE 318
Practice Address - Street 2:
Practice Address - City:LANHAM
Practice Address - State:MD
Practice Address - Zip Code:20706-6231
Practice Address - Country:US
Practice Address - Phone:202-817-0027
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-21
Last Update Date:2023-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCRN967940363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC018352024Medicaid