Provider Demographics
NPI:1548849748
Name:LOVELACE, ELLEN (MPH, NTP, RWS)
Entity type:Individual
Prefix:
First Name:ELLEN
Middle Name:
Last Name:LOVELACE
Suffix:
Gender:F
Credentials:MPH, NTP, RWS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1095 NORMINGTON WAY
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95136-1433
Mailing Address - Country:US
Mailing Address - Phone:408-547-7480
Mailing Address - Fax:
Practice Address - Street 1:1095 NORMINGTON WAY
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95136-1433
Practice Address - Country:US
Practice Address - Phone:408-547-7480
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-05
Last Update Date:2021-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach