Provider Demographics
NPI:1922383330
Name:LOVELY, KATELYN MARIE PIO (NP)
Entity Type:Individual
Prefix:
First Name:KATELYN
Middle Name:MARIE PIO
Last Name:LOVELY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:1 MEDICAL CENTER DR
Mailing Address - Street 2:
Mailing Address - City:BIDDEFORD
Mailing Address - State:ME
Mailing Address - Zip Code:04005-9422
Mailing Address - Country:US
Mailing Address - Phone:207-283-7000
Mailing Address - Fax:207-282-9128
Practice Address - Street 1:10 GOODALL DRIVE
Practice Address - Street 2:
Practice Address - City:EAST WATERBORO
Practice Address - State:ME
Practice Address - Zip Code:04030
Practice Address - Country:US
Practice Address - Phone:207-490-7760
Practice Address - Fax:207-247-8460
Is Sole Proprietor?:No
Enumeration Date:2011-10-17
Last Update Date:2018-05-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MECNP141027363LF0000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME1922383330Medicaid