Provider Demographics
NPI:1861989832
Name:LOVAT, NICOLE ELEANOR J (MD)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:ELEANOR J
Last Name:LOVAT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2860 10TH AVE N STE 350
Mailing Address - Street 2:
Mailing Address - City:GRAND FORKS
Mailing Address - State:ND
Mailing Address - Zip Code:58203-2276
Mailing Address - Country:US
Mailing Address - Phone:701-757-1440
Mailing Address - Fax:
Practice Address - Street 1:2860 10TH AVE N STE 350
Practice Address - Street 2:
Practice Address - City:GRAND FORKS
Practice Address - State:ND
Practice Address - Zip Code:58203-2276
Practice Address - Country:US
Practice Address - Phone:701-757-1440
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-16
Last Update Date:2025-02-22
Deactivation Date:2025-02-03
Deactivation Code:
Reactivation Date:2025-02-20
Provider Licenses
StateLicense IDTaxonomies
MN64131207P00000X, 207Q00000X, 207Q00000X
WAMD60913775207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine