Provider Demographics
NPI:1568710036
Name:LOVELESS, CHARLENE ANN (LPN)
Entity Type:Individual
Prefix:MRS
First Name:CHARLENE
Middle Name:ANN
Last Name:LOVELESS
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 1:1218 WELLMAN RD
Mailing Address - Street 2:
Mailing Address - City:ASHVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14710-9571
Mailing Address - Country:US
Mailing Address - Phone:716-763-0959
Mailing Address - Fax:
Practice Address - Street 1:1218 WELLMAN RD
Practice Address - Street 2:
Practice Address - City:ASHVILLE
Practice Address - State:NY
Practice Address - Zip Code:14710-9571
Practice Address - Country:US
Practice Address - Phone:716-763-0959
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-15
Last Update Date:2012-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY242473-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse