Provider Demographics
NPI:1235818493
Name:LOVE, FAWN MARIE
Entity Type:Individual
Prefix:
First Name:FAWN
Middle Name:MARIE
Last Name:LOVE
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 1:4502 GALLIA ST
Mailing Address - Street 2:
Mailing Address - City:NEW BOSTON
Mailing Address - State:OH
Mailing Address - Zip Code:45662-5541
Mailing Address - Country:US
Mailing Address - Phone:740-529-7020
Mailing Address - Fax:
Practice Address - Street 1:4502 GALLIA ST
Practice Address - Street 2:
Practice Address - City:NEW BOSTON
Practice Address - State:OH
Practice Address - Zip Code:45662-5541
Practice Address - Country:US
Practice Address - Phone:740-529-7020
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-14
Last Update Date:2023-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
No372500000XNursing Service Related ProvidersChore Provider