Provider Demographics
NPI:1609929918
Name:LOVELACE, DERENDA FARMER (RN, BSN, BS)
Entity Type:Individual
Prefix:MS
First Name:DERENDA
Middle Name:FARMER
Last Name:LOVELACE
Suffix:
Gender:F
Credentials:RN, BSN, BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15912 HAMPTON GLEN CT
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23832-1962
Mailing Address - Country:US
Mailing Address - Phone:804-739-3583
Mailing Address - Fax:
Practice Address - Street 1:700 24TH ST
Practice Address - Street 2:
Practice Address - City:FORT LEE
Practice Address - State:VA
Practice Address - Zip Code:23801-1716
Practice Address - Country:US
Practice Address - Phone:804-734-9294
Practice Address - Fax:804-734-9379
Is Sole Proprietor?:No
Enumeration Date:2007-01-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001070722163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management