Provider Demographics
NPI:1750647756
Name:LOVE, TANESHA (LPN)
Entity Type:Individual
Prefix:
First Name:TANESHA
Middle Name:
Last Name:LOVE
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:317 DOCTORS PATH
Mailing Address - Street 2:
Mailing Address - City:RIVERHEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11901-1510
Mailing Address - Country:US
Mailing Address - Phone:631-284-9577
Mailing Address - Fax:
Practice Address - Street 1:317 DOCTORS PATH
Practice Address - Street 2:
Practice Address - City:RIVERHEAD
Practice Address - State:NY
Practice Address - Zip Code:11901-1510
Practice Address - Country:US
Practice Address - Phone:631-284-9577
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-04
Last Update Date:2012-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY282635164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse