Provider Demographics
NPI:1750659314
Name:LOVE, SHERICE
Entity Type:Individual
Prefix:
First Name:SHERICE
Middle Name:
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 1:3920 N 40TH ST
Mailing Address - Street 2:3920 N 40TH ST
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53216-2519
Mailing Address - Country:US
Mailing Address - Phone:414-688-9090
Mailing Address - Fax:
Practice Address - Street 1:3920 N 40TH ST
Practice Address - Street 2:3920 N 40TH ST
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53216-2519
Practice Address - Country:US
Practice Address - Phone:414-688-9090
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-09
Last Update Date:2011-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver