Provider Demographics
NPI:1831594563
Name:LOVE, LOIS (RN)
Entity type:Individual
Prefix:
First Name:LOIS
Middle Name:
Last Name: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 1:1 RAIDER LN
Mailing Address - Street 2:
Mailing Address - City:HORSEHEADS
Mailing Address - State:NY
Mailing Address - Zip Code:14845-2344
Mailing Address - Country:US
Mailing Address - Phone:607-739-5601
Mailing Address - Fax:607-795-2445
Practice Address - Street 1:1 RAIDER LN
Practice Address - Street 2:
Practice Address - City:HORSEHEADS
Practice Address - State:NY
Practice Address - Zip Code:14845-2344
Practice Address - Country:US
Practice Address - Phone:607-739-5601
Practice Address - Fax:607-795-2445
Is Sole Proprietor?:No
Enumeration Date:2014-10-23
Last Update Date:2015-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY291577-1163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool