Basic Information
Provider Information
NPI: 1417366857
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: LOVETTO
FirstName: RENAE
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 2868 ACTON ROAD
Address2:  
City: BIRMINGHAM
State: AL
PostalCode: 352432502
CountryCode: US
TelephoneNumber: 2059688360
FaxNumber: 2059688361
Practice Location
Address1: 2868 ACTON ROAD
Address2:  
City: BIRMINGHAM
State: AL
PostalCode: 352432502
CountryCode: US
TelephoneNumber: 2059688361
FaxNumber: 2059688361
Other Information
ProviderEnumerationDate: 08/11/2014
LastUpdateDate: 08/11/2014
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
163W00000X1-105588ALY Nursing Service ProvidersRegistered Nurse 

No ID Information.


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