Provider Demographics
NPI:1871216069
Name:LOVELESS, NICOLE (RN,LENS PRACTITIONER)
Entity type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:
Last Name:LOVELESS
Suffix:
Gender:F
Credentials:RN,LENS PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 S 2ND ST
Mailing Address - Street 2:
Mailing Address - City:FULTON
Mailing Address - State:NY
Mailing Address - Zip Code:13069-2346
Mailing Address - Country:US
Mailing Address - Phone:315-297-4018
Mailing Address - Fax:
Practice Address - Street 1:201 S 2ND ST
Practice Address - Street 2:
Practice Address - City:FULTON
Practice Address - State:NY
Practice Address - Zip Code:13069-2346
Practice Address - Country:US
Practice Address - Phone:315-297-4018
Practice Address - Fax:
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
NY645618163W00000X, 163WP0808X, 208VP0014X
171400000X
NY246ZE0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZE0500XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherEEG
No163W00000XNursing Service ProvidersRegistered Nurse
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
No171400000XOther Service ProvidersHealth & Wellness Coach
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine