Provider Demographics
NPI:1770638744
Name:AMAYANVBO, LOVETH (ADMINISTRATOR)
Entity Type:Individual
Prefix:
First Name:LOVETH
Middle Name:
Last Name:AMAYANVBO
Suffix:
Gender:F
Credentials:ADMINISTRATOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5901 BROOKLYN BLVD
Mailing Address - Street 2:STE 211
Mailing Address - City:BROOKLYN CENTER
Mailing Address - State:MN
Mailing Address - Zip Code:55429-2517
Mailing Address - Country:US
Mailing Address - Phone:763-971-8888
Mailing Address - Fax:763-971-8892
Practice Address - Street 1:5901 BROOKLYN BLVD
Practice Address - Street 2:STE 211
Practice Address - City:BROOKLYN CENTER
Practice Address - State:MN
Practice Address - Zip Code:55429-2517
Practice Address - Country:US
Practice Address - Phone:763-971-8888
Practice Address - Fax:763-971-8892
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-23
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide