Provider Demographics
NPI:1811397227
Name:LOVELY, AMY
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:LOVELY
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 1:2624 SAYBROOK DR
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:OH
Mailing Address - Zip Code:45044-7168
Mailing Address - Country:US
Mailing Address - Phone:513-393-1538
Mailing Address - Fax:
Practice Address - Street 1:2624 SAYBROOK DR
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:OH
Practice Address - Zip Code:45044-7168
Practice Address - Country:US
Practice Address - Phone:513-393-1538
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-04
Last Update Date:2014-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH401419310712376K00000X
OH400487190505376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide