Provider Demographics
NPI:1285278564
Name:SOVA, LOLITA DONDRIANO
Entity type:Individual
Prefix:
First Name:LOLITA
Middle Name:DONDRIANO
Last Name:SOVA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:310 PITNEY LN UNIT 68
Mailing Address - Street 2:
Mailing Address - City:JUNCTION CITY
Mailing Address - State:OR
Mailing Address - Zip Code:97448-9675
Mailing Address - Country:US
Mailing Address - Phone:805-450-8480
Mailing Address - Fax:
Practice Address - Street 1:310 PITNEY LN UNIT 68
Practice Address - Street 2:
Practice Address - City:JUNCTION CITY
Practice Address - State:OR
Practice Address - Zip Code:97448-9675
Practice Address - Country:US
Practice Address - Phone:805-450-8480
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-30
Last Update Date:2019-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201907680LPN164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse