Healthcare Provider Details

I. General information

NPI: 1922093558
Provider Name (Legal Business Name): MARGARET MICHELE LOVELL PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SHELLEY LOVELL

II. Dates (important events)

Enumeration Date: 09/20/2005
Last Update Date: 10/01/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1950 CIRCLE OF HOPE DR N1550
SALT LAKE CITY UT
84112-5500
US

IV. Provider business mailing address

1121 E 3900 S STE C230
SALT LAKE CITY UT
84124-1297
US

V. Phone/Fax

Practice location:
  • Phone: 801-213-4270
  • Fax: 801-585-1312
Mailing address:
  • Phone: 801-213-4270
  • Fax: 801-585-1312

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number366941-1206
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: