Provider Demographics
NPI:1467022004
Name:IMANATUE, LOVELINE OZIOMA (DNP)
Entity type:Individual
Prefix:DR
First Name:LOVELINE
Middle Name:OZIOMA
Last Name:IMANATUE
Suffix:
Gender:
Credentials:DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4550 KRUSE WAY STE 125
Mailing Address - Street 2:
Mailing Address - City:LAKE OSWEGO
Mailing Address - State:OR
Mailing Address - Zip Code:97035-3533
Mailing Address - Country:US
Mailing Address - Phone:458-600-2389
Mailing Address - Fax:877-323-0696
Practice Address - Street 1:4550 KRUSE WAY
Practice Address - Street 2:
Practice Address - City:LAKE OSWEGO
Practice Address - State:OR
Practice Address - Zip Code:97035-3594
Practice Address - Country:US
Practice Address - Phone:458-600-2389
Practice Address - Fax:877-323-0696
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-27
Last Update Date:2025-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2020044450363LA2200X, 363LG0600X, 363LP2300X
AZ257896363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care