Provider Demographics
NPI:1780017541
Name:LOVE, YALONDRA R (LMT)
Entity Type:Individual
Prefix:
First Name:YALONDRA
Middle Name:R
Last Name:LOVE
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1079 IRONGATE LN
Mailing Address - Street 2:APT D
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43213-3243
Mailing Address - Country:US
Mailing Address - Phone:614-288-7966
Mailing Address - Fax:
Practice Address - Street 1:5300 E MAIN ST
Practice Address - Street 2:SUITE 100
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43213-2580
Practice Address - Country:US
Practice Address - Phone:614-288-7966
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-15
Last Update Date:2013-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH33020771172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker