MEDICARE: LOVELLE O. RALLS ARNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	AP60100988	WA

General Provider Information

NPI Number	:	1538150800
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LOVELLE O. RALLS ARNP

Provider Business Mailing Address
First Line	:	PO BOX 25608
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84125-0608
Country	:	US
Telephone Number	:	206-320-4476
Fax Number	:	206-568-7043

Provider Business Practice Location Address
First Line	:	550 17TH AVE FL 5
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98122-5788
Country	:	US
Telephone Number	:	206-320-2800
Fax Number	:	206-320-2827

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/04/2005
Last Update Date	:	06/22/2021

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