Provider Demographics
NPI:1629150610
Name:LOVRO, SUSAN UPTON
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:UPTON
Last Name:LOVRO
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:PO BOX 710
Mailing Address - Street 2:HWY 50
Mailing Address - City:PECOS
Mailing Address - State:NM
Mailing Address - Zip Code:87552
Mailing Address - Country:US
Mailing Address - Phone:505-757-6482
Mailing Address - Fax:
Practice Address - Street 1:3 HIGHWAY 50
Practice Address - Street 2:#D
Practice Address - City:PECOS
Practice Address - State:NM
Practice Address - Zip Code:87552
Practice Address - Country:US
Practice Address - Phone:505-757-6482
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMPA2006-0023363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant