Provider Demographics
NPI:1922093558
Name:LOVELL, MARGARET MICHELE (PA)
Entity Type:Individual
Prefix:
First Name:MARGARET
Middle Name:MICHELE
Last Name:LOVELL
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:SHELLEY
Other - Middle Name:
Other - Last Name:LOVELL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1121 E 3900 S
Mailing Address - Street 2:STE C230
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84124-1297
Mailing Address - Country:US
Mailing Address - Phone:801-213-4270
Mailing Address - Fax:801-585-1312
Practice Address - Street 1:1950 CIRCLE OF HOPE DR
Practice Address - Street 2:N1550
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84112-5500
Practice Address - Country:US
Practice Address - Phone:801-213-4270
Practice Address - Fax:801-585-1312
Is Sole Proprietor?:No
Enumeration Date:2005-09-20
Last Update Date:2018-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT366941-1206363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2006646Medicaid
OR500604424Medicaid
OR500604424Medicaid
ORR132233Medicare PIN