Provider Demographics
NPI:1902001712
Name:LOVORN, DANA LYNNE (FNP, ACNP, ENP)
Entity Type:Individual
Prefix:MS
First Name:DANA
Middle Name:LYNNE
Last Name:LOVORN
Suffix:
Gender:F
Credentials:FNP, ACNP, ENP
Other - Prefix:MRS
Other - First Name:DANA
Other - Middle Name:LYNNE
Other - Last Name:DEAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP, ACNP
Mailing Address - Street 1:80111 BRIDGEPORT DR
Mailing Address - Street 2:
Mailing Address - City:INDIO
Mailing Address - State:CA
Mailing Address - Zip Code:92201-0512
Mailing Address - Country:US
Mailing Address - Phone:760-787-6276
Mailing Address - Fax:
Practice Address - Street 1:39000 BOB HOPE DR
Practice Address - Street 2:
Practice Address - City:RANCHO MIRAGE
Practice Address - State:CA
Practice Address - Zip Code:92270-3221
Practice Address - Country:US
Practice Address - Phone:760-610-7210
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-20
Last Update Date:2023-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20719363LA2100X, 363LF0000X, 363LF0000X, 363LA2100X
AZAP2931363LA2100X
AZAP2930363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS0126080Medicaid
MS0126080Medicaid
MSS29081Medicare UPIN