Provider Demographics
NPI:1518644160
Name:WEDDERBURN, LOVERNE MARCIA
Entity type:Individual
Prefix:MRS
First Name:LOVERNE
Middle Name:MARCIA
Last Name:WEDDERBURN
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 1:6 BROWER BLVD
Mailing Address - Street 2:
Mailing Address - City:HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:12538-1612
Mailing Address - Country:US
Mailing Address - Phone:845-489-3643
Mailing Address - Fax:
Practice Address - Street 1:6 BROWER BLVD
Practice Address - Street 2:
Practice Address - City:HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:12538-1612
Practice Address - Country:US
Practice Address - Phone:845-489-3643
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-05
Last Update Date:2023-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY5888861163WM0705X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical