Provider Demographics
NPI:1619520210
Name:LOVELY, BRENDA L (APRN)
Entity type:Individual
Prefix:
First Name:BRENDA
Middle Name:L
Last Name:LOVELY
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 JOHN HARDIE WAY
Mailing Address - Street 2:
Mailing Address - City:CHICHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03258-2100
Mailing Address - Country:US
Mailing Address - Phone:603-856-3905
Mailing Address - Fax:
Practice Address - Street 1:70 COMMERCIAL ST STE 200
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NH
Practice Address - Zip Code:03301-5094
Practice Address - Country:US
Practice Address - Phone:603-689-7890
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-23
Last Update Date:2024-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH056503-23363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health