Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225400000X | Rehabilitation Practitioner |
NPI | 1043670847 |
---|---|
Provider Name | Irene Lovelace |
First Address | Boulder City, NV 89005-1614 |
Second Address | Boulder City, NV 89005-1614 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/03/2016 |
Last Update Date | 07/03/2016 |