Provider Demographics
NPI:1194212381
Name:DRAPER, STARR LOVE
Entity Type:Individual
Prefix:MS
First Name:STARR
Middle Name:LOVE
Last Name:DRAPER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1335
Mailing Address - Street 2:
Mailing Address - City:CHINLE
Mailing Address - State:AZ
Mailing Address - Zip Code:86503-1335
Mailing Address - Country:US
Mailing Address - Phone:928-221-9917
Mailing Address - Fax:866-869-6037
Practice Address - Street 1:1/4 MI S OF CHINLE IHS
Practice Address - Street 2:
Practice Address - City:CHINLE
Practice Address - State:AZ
Practice Address - Zip Code:86503-1335
Practice Address - Country:US
Practice Address - Phone:928-221-9917
Practice Address - Fax:866-869-6037
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-13
Last Update Date:2019-12-11
Deactivation Date:2018-10-30
Deactivation Code:
Reactivation Date:2019-01-14
Provider Licenses
StateLicense IDTaxonomies
AZ251E00000X
374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No374U00000XNursing Service Related ProvidersHome Health Aide