Provider Demographics
NPI:1477366482
Name:LOVELL, ANGELETTE AMANDA (RDN)
Entity type:Individual
Prefix:
First Name:ANGELETTE
Middle Name:AMANDA
Last Name:LOVELL
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:ANGELETTE
Other - Middle Name:AMANDA
Other - Last Name:NILSSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD
Mailing Address - Street 1:2343 ANDREW ST
Mailing Address - Street 2:
Mailing Address - City:POCATELLO
Mailing Address - State:ID
Mailing Address - Zip Code:83201-7913
Mailing Address - Country:US
Mailing Address - Phone:801-928-9819
Mailing Address - Fax:
Practice Address - Street 1:2327 CORONADO ST
Practice Address - Street 2:
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83404-7407
Practice Address - Country:US
Practice Address - Phone:208-528-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-31
Last Update Date:2025-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDD-1072133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered