Provider Demographics
NPI:1821611245
Name:WALINJOM, LOVELINE IJANG
Entity Type:Individual
Prefix:
First Name:LOVELINE
Middle Name:IJANG
Last Name:WALINJOM
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 1:119 NEWBURY ST APT 10
Mailing Address - Street 2:
Mailing Address - City:BROCKTON
Mailing Address - State:MA
Mailing Address - Zip Code:02301-3800
Mailing Address - Country:US
Mailing Address - Phone:857-615-9637
Mailing Address - Fax:
Practice Address - Street 1:119 NEWBURY ST APT 10
Practice Address - Street 2:
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02301-3800
Practice Address - Country:US
Practice Address - Phone:857-615-9637
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-20
Last Update Date:2020-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA94993164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse