Provider Demographics
NPI:1548238470
Name:LOVITZ, WANDA
Entity Type:Individual
Prefix:MRS
First Name:WANDA
Middle Name:
Last Name:LOVITZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2204 SHAKER RUN RD
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40509-8475
Mailing Address - Country:US
Mailing Address - Phone:859-294-9489
Mailing Address - Fax:
Practice Address - Street 1:2204 SHAKER RUN RD
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40509-8475
Practice Address - Country:US
Practice Address - Phone:859-294-9489
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-08
Last Update Date:2008-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3734P363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY78010212Medicaid
000000490014OtherBC BS LPC
7450533OtherAETNA
1206234OtherCHA HHC
000000321167OtherBC BS HHC
KY78010212Medicaid
1206234OtherCHA HHC
000000490014OtherBC BS LPC