Healthcare Provider Details

I. General information

NPI: 1891935185
Provider Name (Legal Business Name): SHARLENA A LOVY PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/25/2009
Last Update Date: 07/17/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

425 CHERRY ST SE
GRAND RAPIDS MI
49503-4601
US

IV. Provider business mailing address

3641 BYRON CENTER AVE SW
WYOMING MI
49519-3665
US

V. Phone/Fax

Practice location:
  • Phone: 616-774-7005
  • Fax: 616-774-0516
Mailing address:
  • Phone: 616-531-3070
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number5601003780
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: