Provider Demographics
NPI:1508560574
Name:ONE LOVE, SUSANNE (RN)
Entity type:Individual
Prefix:
First Name:SUSANNE
Middle Name:
Last Name:ONE LOVE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3103 TOHO TRL
Mailing Address - Street 2:
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86005-3778
Mailing Address - Country:US
Mailing Address - Phone:928-856-9265
Mailing Address - Fax:
Practice Address - Street 1:3103 TOHO TRL
Practice Address - Street 2:
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86005-3778
Practice Address - Country:US
Practice Address - Phone:928-856-9265
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-27
Last Update Date:2024-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN152849163WC1500X, 163WG0000X, 163WM0102X, 163WP0000X, 163WP2201X, 163WX0800X, 163WW0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WW0101XNursing Service ProvidersRegistered NurseWomen's Health Care, Ambulatory
No163WC1500XNursing Service ProvidersRegistered NurseCommunity Health
No163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice
No163WM0102XNursing Service ProvidersRegistered NurseMaternal Newborn
No163WP0000XNursing Service ProvidersRegistered NursePain Management
No163WP2201XNursing Service ProvidersRegistered NurseAmbulatory Care
No163WX0800XNursing Service ProvidersRegistered NurseOrthopedic