Provider Demographics
NPI:1275799173
Name:BOOZE-LOVE, AHNYA M (NP)
Entity Type:Individual
Prefix:
First Name:AHNYA
Middle Name:M
Last Name:BOOZE-LOVE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:AHNYA
Other - Middle Name:M
Other - Last Name:BOOZE-LOVE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:1115 SE 164TH AVE DEPT 358
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98683-8004
Mailing Address - Country:US
Mailing Address - Phone:360-729-1459
Mailing Address - Fax:360-729-3066
Practice Address - Street 1:1200 HILYARD ST
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-8122
Practice Address - Country:US
Practice Address - Phone:458-205-6543
Practice Address - Fax:458-205-6492
Is Sole Proprietor?:No
Enumeration Date:2008-07-31
Last Update Date:2018-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAP126377363LF0000X
OR201801075NP-PP363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily