Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0122X | Plastic and Reconstructive Surgery | 0433345 | KS |
NPI | 1134222672 |
---|---|
Provider Name | Susan Lovelle-Allen |
First Address | Newton, KS 67114-8940 |
Second Address | Newton, KS 67114-9013 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/09/2006 |
Last Update Date | 02/04/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
111178020 | PTAN (01) | KS |
200585240C | (05) | KS |