Healthcare Provider Details

I. General information

NPI: 1295666493
Provider Name (Legal Business Name): ALYCIA MARIE ANGEL LOVATO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2026
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13 E COURT DR
EMERADO ND
58228-4033
US

IV. Provider business mailing address

13 E COURT DR
EMERADO ND
58228-4033
US

V. Phone/Fax

Practice location:
  • Phone: 269-556-5697
  • Fax:
Mailing address:
  • Phone: 269-556-5697
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number1480810
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: