Provider Demographics
NPI:1306304571
Name:AMOLO, LOVIE MARIE DAVID (MSN, RN, ACCNS-AG)
Entity type:Individual
Prefix:
First Name:LOVIE MARIE
Middle Name:DAVID
Last Name:AMOLO
Suffix:
Gender:F
Credentials:MSN, RN, ACCNS-AG
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:391 LITTLE CLOVE RD
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10301-4126
Mailing Address - Country:US
Mailing Address - Phone:718-447-4609
Mailing Address - Fax:
Practice Address - Street 1:4802 10TH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11219-2916
Practice Address - Country:US
Practice Address - Phone:718-283-2548
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-06
Last Update Date:2019-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY605291364SE0003X, 364SA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes364SE0003XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistEmergencyGroup - Single Specialty
No364SA2100XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAcute CareGroup - Single Specialty