Provider Demographics
NPI:1629402920
Name:BRIDGETTE LOVE
Entity Type:Organization
Organization Name:BRIDGETTE LOVE
Other - Org Name:BRIDGETTE LOVE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:REGISTERED NURSE/ICU
Authorized Official - Prefix:
Authorized Official - First Name:BRIDGETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:LOVE
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:773-924-5377
Mailing Address - Street 1:4045 S LAKE PARK AVE # 302
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60653-2578
Mailing Address - Country:US
Mailing Address - Phone:773-924-5377
Mailing Address - Fax:
Practice Address - Street 1:4045 S LAKE PARK AVE # 302
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60653-2578
Practice Address - Country:US
Practice Address - Phone:773-924-5377
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-22
Last Update Date:2013-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0413192392865M2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2865M2000XHospitalsMilitary HospitalMilitary General Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========Medicaid
IL=========Medicare UPIN
IL=========1Medicare NSC