Provider Demographics
NPI:1154370500
Name:LOVEJOY, BRUCE OWEN (APRN-NP)
Entity type:Individual
Prefix:MR
First Name:BRUCE
Middle Name:OWEN
Last Name:LOVEJOY
Suffix:
Gender:M
Credentials:APRN-NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 24406
Mailing Address - Street 2:WEIGHT LOSS SURGICAL CENTER
Mailing Address - City:SHAWNEE MISSION
Mailing Address - State:KS
Mailing Address - Zip Code:66283
Mailing Address - Country:US
Mailing Address - Phone:402-201-2920
Mailing Address - Fax:402-201-2923
Practice Address - Street 1:625 N. 114TH STREET
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68154
Practice Address - Country:US
Practice Address - Phone:402-201-2920
Practice Address - Fax:402-201-2923
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2011-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE110411363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47078557552Medicaid
NE273757Medicare ID - Type Unspecified
NEP23699Medicare UPIN