Provider Demographics
NPI:1053455287
Name:LOV, MARY ANN (RNFA)
Entity Type:Individual
Prefix:MS
First Name:MARY ANN
Middle Name:
Last Name:LOV
Suffix:
Gender:F
Credentials:RNFA
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 82649
Mailing Address - Street 2:
Mailing Address - City:CONYERS
Mailing Address - State:GA
Mailing Address - Zip Code:30013-9439
Mailing Address - Country:US
Mailing Address - Phone:770-403-3615
Mailing Address - Fax:678-625-9670
Practice Address - Street 1:3355 SALEM COVE TRL SE
Practice Address - Street 2:
Practice Address - City:CONYERS
Practice Address - State:GA
Practice Address - Zip Code:30013-5310
Practice Address - Country:US
Practice Address - Phone:770-403-3615
Practice Address - Fax:678-625-9670
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN052475163WR0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First Assistant