Organization
LOVELYVEINSHOLISTICLABORATORY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. BRIDGET NICOLE GORDON A.A.S (CEO/ CLINICAL DIRECTOR)
(502) 922-6653
Entity
Organization
Contact information
Practice address
212 N 2ND ST STE 100, RICHMOND, KY 40475-1408
(502) 922-6653
Mailing address
1935 S HURSTBOURNE PKWY # 1129, LOUISVILLE, KY 40220-1645
(502) 922-6653
Taxonomy
Speciality
Code
Description
License number
State
246RP1900X
Phlebotomy Technician
Primary
—
—
305S00000X
Point of Service
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
18D2277377
CLIA
KY
Enumeration date
08/08/2023
Last updated
06/06/2025
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