Provider Demographics
NPI:1063845055
Name:LOVE, PENNI (RN)
Entity Type:Individual
Prefix:
First Name:PENNI
Middle Name:
Last Name:LOVE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:987 KINGS PKWY
Mailing Address - Street 2:
Mailing Address - City:NORTH BALDWIN
Mailing Address - State:NY
Mailing Address - Zip Code:11510-2106
Mailing Address - Country:US
Mailing Address - Phone:800-931-3568
Mailing Address - Fax:800-931-3568
Practice Address - Street 1:987 KINGS PKWY
Practice Address - Street 2:
Practice Address - City:NORTH BALDWIN
Practice Address - State:NY
Practice Address - Zip Code:11510-2106
Practice Address - Country:US
Practice Address - Phone:800-931-3568
Practice Address - Fax:800-931-3568
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-14
Last Update Date:2013-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY345398-1163WA2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA2000XNursing Service ProvidersRegistered NurseAdministrator