Provider Demographics
NPI:1801334057
Name:LOVE, LAURA (PHD, PA-C)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:LOVE
Suffix:
Gender:F
Credentials:PHD, PA-C
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:
Other - Last Name:WITTE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD, PA-C
Mailing Address - Street 1:1593 W BROWNING WAY
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85286-0908
Mailing Address - Country:US
Mailing Address - Phone:480-262-1792
Mailing Address - Fax:
Practice Address - Street 1:3377 S PRICE RD
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85248-3573
Practice Address - Country:US
Practice Address - Phone:480-525-7874
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-08
Last Update Date:2024-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ6643363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant