Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0005X | Nurse Practitioner - Neonatal (Critical Care) | 3021033 | WI |
NPI | 1245467570 |
---|---|
Provider Name | Mrs. Vicky Rachelle Loveridge |
First Address | Appleton, WI 54913-6610 |
Second Address | Appleton, WI 54913-6610 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/06/2009 |
Last Update Date | 13/06/2009 |