1720392483 NPI number — AMBER NICHOLE LOVELESS LMT, CMMT

Table of content: AMBER NICHOLE LOVELESS LMT, CMMT (NPI 1720392483)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720392483 NPI number — AMBER NICHOLE LOVELESS LMT, CMMT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LOVELESS
Provider First Name:
AMBER
Provider Middle Name:
NICHOLE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LMT, CMMT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
DRIESEN
Provider Other First Name:
AMBER
Provider Other Middle Name:
NICHOLE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1720392483
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/04/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4945 ELM ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EVERETT
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98203-2620
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
425-268-6289
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1920 100TH ST SE
Provider Second Line Business Practice Location Address:
A3
Provider Business Practice Location Address City Name:
EVERETT
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98208
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
425-268-6289
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/04/2010

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225700000X , with the licence number:  MA00021847 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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