Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0200X | Nurse Practitioner - Pediatrics | AP09870 | LA |
NPI | 1043703010 |
---|---|
Provider Name | Mrs. Samantha Lee Lovecchio |
First Address | Mandeville, LA 70471-3242 |
Second Address | Gretna, LA 70056-5280 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/06/2018 |
Last Update Date | 16/06/2018 |