Provider Demographics
NPI:1740316025
Name:LOVE, LAURIE (RN, MSN, FNP-BC)
Entity type:Individual
Prefix:MS
First Name:LAURIE
Middle Name:
Last Name:LOVE
Suffix:
Gender:F
Credentials:RN, MSN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28212 KELLY JOHNSON PKWY
Mailing Address - Street 2:SUITE 230
Mailing Address - City:SANTA CLARITA
Mailing Address - State:CA
Mailing Address - Zip Code:91355-5084
Mailing Address - Country:US
Mailing Address - Phone:661-295-7777
Mailing Address - Fax:661-295-7778
Practice Address - Street 1:28212 KELLY JOHNSON PKWY
Practice Address - Street 2:SUITE 230
Practice Address - City:VALENCIA
Practice Address - State:CA
Practice Address - Zip Code:91355-5084
Practice Address - Country:US
Practice Address - Phone:661-295-7777
Practice Address - Fax:661-295-7778
Is Sole Proprietor?:No
Enumeration Date:2007-02-23
Last Update Date:2010-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA524263363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAP45641Medicare UPIN