Provider Demographics
NPI:1760166326
Name:LOVE, SONJA (NDTR)
Entity Type:Individual
Prefix:
First Name:SONJA
Middle Name:
Last Name:LOVE
Suffix:
Gender:F
Credentials:NDTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 LAURA ELIZABETH CT
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:76063-5188
Mailing Address - Country:US
Mailing Address - Phone:720-220-6215
Mailing Address - Fax:
Practice Address - Street 1:8 LAURA ELIZABETH CT
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:TX
Practice Address - Zip Code:76063-5188
Practice Address - Country:US
Practice Address - Phone:720-220-6215
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-14
Last Update Date:2023-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX86037585133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist