Provider Demographics
NPI:1023325149
Name:LOVELACE, RENADA NOVIA
Entity type:Individual
Prefix:MS
First Name:RENADA
Middle Name:NOVIA
Last Name:LOVELACE
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 1:4591 OAKFIELD CT
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28314-2464
Mailing Address - Country:US
Mailing Address - Phone:860-997-9232
Mailing Address - Fax:
Practice Address - Street 1:5114 YADKIN RD
Practice Address - Street 2:SUITE 136
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28303-6012
Practice Address - Country:US
Practice Address - Phone:860-997-9232
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-10
Last Update Date:2010-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC80326332B00000X, 335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No335E00000XSuppliersProsthetic/Orthotic Supplier