Provider Demographics
NPI:1528710837
Name:NYLUND, LOVELY EBAJAN (LPN)
Entity type:Individual
Prefix:
First Name:LOVELY
Middle Name:EBAJAN
Last Name:NYLUND
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:640 SW GOLDEN HILLS DR APT A202
Mailing Address - Street 2:
Mailing Address - City:PULLMAN
Mailing Address - State:WA
Mailing Address - Zip Code:99163-6710
Mailing Address - Country:US
Mailing Address - Phone:509-332-9903
Mailing Address - Fax:
Practice Address - Street 1:17 E 8TH AVE
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99202-1201
Practice Address - Country:US
Practice Address - Phone:509-474-2151
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-19
Last Update Date:2022-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALP60888834164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA11351185900OtherBLUECROSS BLUESHIELD