Provider Demographics
NPI:1619571817
Name:LOVE, ROSALYN M (STNA)
Entity Type:Individual
Prefix:
First Name:ROSALYN
Middle Name:M
Last Name:LOVE
Suffix:
Gender:F
Credentials:STNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2820 AIRPORT HWY APT G
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43609-1560
Mailing Address - Country:US
Mailing Address - Phone:156-725-5709
Mailing Address - Fax:
Practice Address - Street 1:1211 MONTROSE AVE
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43607-3726
Practice Address - Country:US
Practice Address - Phone:419-409-4995
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-28
Last Update Date:2020-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH602245310920376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes376K00000XNursing Service Related ProvidersNurse's AideGroup - Single Specialty