Provider Demographics
NPI:1962125153
Name:LOVELACE, KIM SUZANNE (MSN, RN, NCSN)
Entity type:Individual
Prefix:
First Name:KIM
Middle Name:SUZANNE
Last Name:LOVELACE
Suffix:
Gender:F
Credentials:MSN, RN, NCSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:715 N CALIFORNIA AVE
Mailing Address - Street 2:
Mailing Address - City:PASCO
Mailing Address - State:WA
Mailing Address - Zip Code:99301-5932
Mailing Address - Country:US
Mailing Address - Phone:509-416-7810
Mailing Address - Fax:509-416-7817
Practice Address - Street 1:715 N CALIFORNIA AVE
Practice Address - Street 2:
Practice Address - City:PASCO
Practice Address - State:WA
Practice Address - Zip Code:99301-5932
Practice Address - Country:US
Practice Address - Phone:509-416-7810
Practice Address - Fax:509-416-7817
Is Sole Proprietor?:No
Enumeration Date:2022-09-22
Last Update Date:2022-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN00092467163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse