Provider Demographics
NPI:1477377497
Name:BOONE, LOVETTA S
Entity type:Individual
Prefix:
First Name:LOVETTA
Middle Name:S
Last Name:BOONE
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 1:3026 TYRE NECK RD STE E
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:VA
Mailing Address - Zip Code:23703-4500
Mailing Address - Country:US
Mailing Address - Phone:404-668-8328
Mailing Address - Fax:
Practice Address - Street 1:3026 TYRE NECK RD STE E
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:VA
Practice Address - Zip Code:23703-4500
Practice Address - Country:US
Practice Address - Phone:404-668-8328
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-15
Last Update Date:2024-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)