Provider Demographics
NPI:1861465197
Name:LOVE, ANNE (NP)
Entity Type:Individual
Prefix:MRS
First Name:ANNE
Middle Name:
Last Name:LOVE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1814 CHARLTON CT STE A
Mailing Address - Street 2:
Mailing Address - City:GOSHEN
Mailing Address - State:IN
Mailing Address - Zip Code:46526-6463
Mailing Address - Country:US
Mailing Address - Phone:574-533-4169
Mailing Address - Fax:574-534-8822
Practice Address - Street 1:1814 CHARLTON CT STE A
Practice Address - Street 2:
Practice Address - City:GOSHEN
Practice Address - State:IN
Practice Address - Zip Code:46526-6463
Practice Address - Country:US
Practice Address - Phone:574-533-4169
Practice Address - Fax:574-534-8822
Is Sole Proprietor?:No
Enumeration Date:2006-02-08
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71001755A363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200458070Medicaid
IN184520KKMedicare PIN
Q32057Medicare UPIN
Q32057Medicare UPIN