Provider Demographics
NPI:1104673896
Name:LOVELESS, RENEE SUZANNE (APRN, PMHNP-BC)
Entity type:Individual
Prefix:
First Name:RENEE
Middle Name:SUZANNE
Last Name:LOVELESS
Suffix:
Gender:F
Credentials:APRN, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:356 W 1880 N
Mailing Address - Street 2:
Mailing Address - City:TOOELE
Mailing Address - State:UT
Mailing Address - Zip Code:84074-9110
Mailing Address - Country:US
Mailing Address - Phone:435-830-2028
Mailing Address - Fax:
Practice Address - Street 1:356 W 1880 N
Practice Address - Street 2:
Practice Address - City:TOOELE
Practice Address - State:UT
Practice Address - Zip Code:84074-9110
Practice Address - Country:US
Practice Address - Phone:435-830-2028
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-01
Last Update Date:2024-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5564658-4405363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health