Healthcare Provider Details

I. General information

NPI: 1932173606
Provider Name (Legal Business Name): MICHAEL L LOVELL CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/17/2006
Last Update Date: 07/07/2022
Certification Date: 07/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1125 PROFESSIONAL BLVD
EVANSVILLE IN
47714-8001
US

IV. Provider business mailing address

1125 PROFESSIONAL BLVD
EVANSVILLE IN
47714-8001
US

V. Phone/Fax

Practice location:
  • Phone: 812-475-1000
  • Fax: 812-475-1001
Mailing address:
  • Phone: 812-475-1000
  • Fax: 812-475-1001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number1071110
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: