Provider Demographics
NPI:1285042069
Name:LOVELL, CHERYL
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:
Last Name:LOVELL
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 1:2111 E BASELINE RD
Mailing Address - Street 2:SUITE B-5
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85283-1516
Mailing Address - Country:US
Mailing Address - Phone:602-595-4663
Mailing Address - Fax:866-236-7997
Practice Address - Street 1:2111 E BASELINE RD
Practice Address - Street 2:SUITE B-5
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85283-1516
Practice Address - Country:US
Practice Address - Phone:602-595-4663
Practice Address - Fax:866-236-7997
Is Sole Proprietor?:No
Enumeration Date:2014-07-24
Last Update Date:2014-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ0000001372600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion