Healthcare Provider Details

I. General information

NPI: 1689186777
Provider Name (Legal Business Name): MICHELLE MARIE LOVELL AGNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/30/2017
Last Update Date: 09/13/2022
Certification Date: 09/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4024 CRESTA PARK AVE NW
ALBUQUERQUE NM
87114-5163
US

IV. Provider business mailing address

4024 CRESTA PARK AVE NW
ALBUQUERQUE NM
87114-5163
US

V. Phone/Fax

Practice location:
  • Phone: 575-595-0150
  • Fax:
Mailing address:
  • Phone: 575-595-0150
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberCNP-03423
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: