Provider Demographics
NPI:1275972242
Name:LOVE, KIYANNA M
Entity Type:Individual
Prefix:
First Name:KIYANNA
Middle Name:M
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 1:283 N MIDLER AVE
Mailing Address - Street 2:2ND FL
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13206-2227
Mailing Address - Country:US
Mailing Address - Phone:315-313-1756
Mailing Address - Fax:
Practice Address - Street 1:283 N MIDLER AVE
Practice Address - Street 2:2ND FL
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13206-2227
Practice Address - Country:US
Practice Address - Phone:315-313-1756
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-22
Last Update Date:2013-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY303270164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse