Provider Demographics
NPI:1265101075
Name:LOVE, IVANA R
Entity type:Individual
Prefix:MRS
First Name:IVANA
Middle Name:R
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 1:4245 W JOLLY RD LOT 23
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48911-3000
Mailing Address - Country:US
Mailing Address - Phone:517-489-1852
Mailing Address - Fax:
Practice Address - Street 1:4245 W JOLLY RD LOT 23
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48911-3000
Practice Address - Country:US
Practice Address - Phone:517-489-1852
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-07
Last Update Date:2021-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health