Provider Demographics
NPI:1568536597
Name:LOVE, DEBORAH SUE (DEBORAH LOVE)
Entity Type:Individual
Prefix:MRS
First Name:DEBORAH
Middle Name:SUE
Last Name:LOVE
Suffix:
Gender:F
Credentials:DEBORAH LOVE
Other - Prefix:MISS
Other - First Name:DEBORAH
Other - Middle Name:SUE
Other - Last Name:HARRIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BSW,BSN,RN,CCR
Mailing Address - Street 1:16 TYNDALE ST
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02131-2304
Mailing Address - Country:US
Mailing Address - Phone:617-833-5463
Mailing Address - Fax:
Practice Address - Street 1:500 COLUMBIA RD
Practice Address - Street 2:
Practice Address - City:DORCHESTER
Practice Address - State:MA
Practice Address - Zip Code:02125-2322
Practice Address - Country:US
Practice Address - Phone:617-825-9206
Practice Address - Fax:617-282-7603
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA167451163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse