Basic Information
| Provider Information | |||||||||
| NPI: | 1760933311 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LOVETT | ||||||||
| FirstName: | NICOLE | ||||||||
| MiddleName: | |||||||||
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| Credential: | FNP-BC | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | ANDRACKI | ||||||||
| OtherFirstName: | NICOLE | ||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 959 SANCTUARY DR | ||||||||
| Address2: | |||||||||
| City: | NEW LENOX | ||||||||
| State: | IL | ||||||||
| PostalCode: | 604515627 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7088227557 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 4511 SAUK TRL | ||||||||
| Address2: | |||||||||
| City: | RICHTON PARK | ||||||||
| State: | IL | ||||||||
| PostalCode: | 604711167 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7087476000 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/19/2016 | ||||||||
| LastUpdateDate: | 10/19/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 209014959 | IL | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.