Provider Demographics
NPI:1679023469
Name:LOVITSCH, KRYSTAL LEIGH (RN)
Entity Type:Individual
Prefix:MRS
First Name:KRYSTAL
Middle Name:LEIGH
Last Name:LOVITSCH
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4536 SHERWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:DOWNERS GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60515-3037
Mailing Address - Country:US
Mailing Address - Phone:630-546-2328
Mailing Address - Fax:
Practice Address - Street 1:4536 SHERWOOD AVE
Practice Address - Street 2:
Practice Address - City:DOWNERS GROVE
Practice Address - State:IL
Practice Address - Zip Code:60515-3037
Practice Address - Country:US
Practice Address - Phone:630-546-2328
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-05
Last Update Date:2016-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041.347645163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse