Provider Demographics
NPI:1750699930
Name:LOVE, WHITNEY DESHAWN (CNA)
Entity type:Individual
Prefix:
First Name:WHITNEY
Middle Name:DESHAWN
Last Name:LOVE
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3305 W 85TH PL
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60652-3758
Mailing Address - Country:US
Mailing Address - Phone:708-446-4301
Mailing Address - Fax:
Practice Address - Street 1:3305 W 85TH PL
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60652-3758
Practice Address - Country:US
Practice Address - Phone:708-446-4301
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-21
Last Update Date:2010-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL376K00000XMedicare Oscar/Certification