1215564554 NPI number — MRS. CHRISTINA LOUISE LOVELY FNP

Table of content: MRS. CHRISTINA LOUISE LOVELY FNP (NPI 1215564554)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215564554 NPI number — MRS. CHRISTINA LOUISE LOVELY FNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LOVELY
Provider First Name:
CHRISTINA
Provider Middle Name:
LOUISE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
FNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
KUBICEK
Provider Other First Name:
CHRISTINA
Provider Other Middle Name:
L
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1215564554
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/05/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3813 HAVEN AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RACINE
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
53405-2325
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
262-939-2926
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3813 HAVEN AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RACINE
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53405-2325
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
262-939-2926
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/26/2020

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363L00000X , with the licence number:  9984-33 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LF0000X , with the licence number: 9984 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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