Healthcare Provider Details

I. General information

NPI: 1124946058
Provider Name (Legal Business Name): JERZIE LOVING
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/08/2026
Last Update Date: 07/08/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20675 E OCOTILLO RD
QUEEN CREEK AZ
85142
US

IV. Provider business mailing address

35698 N CITRUS ST
QUEEN CREEK AZ
85144-0227
US

V. Phone/Fax

Practice location:
  • Phone: 928-243-2011
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085U0001X
TaxonomyDiagnostic Ultrasound Physician
License Number291025
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: