Provider Demographics
NPI:1881580686
Name:REYNOLDS, LOVELLE RONQUILLO (PHD, APRN, FNP-BC)
Entity type:Individual
Prefix:
First Name:LOVELLE
Middle Name:RONQUILLO
Last Name:REYNOLDS
Suffix:
Gender:F
Credentials:PHD, APRN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6841 DEMPSTER ST
Mailing Address - Street 2:
Mailing Address - City:MORTON GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60053-2628
Mailing Address - Country:US
Mailing Address - Phone:224-233-0299
Mailing Address - Fax:
Practice Address - Street 1:6841 DEMPSTER ST
Practice Address - Street 2:
Practice Address - City:MORTON GROVE
Practice Address - State:IL
Practice Address - Zip Code:60053-2628
Practice Address - Country:US
Practice Address - Phone:224-233-0299
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-17
Last Update Date:2025-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.032099363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner