Provider Demographics
NPI:1538929666
Name:LOVE, SAMANTHA L
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:L
Last Name:LOVE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 GRANDVIEW BLVD APT B115
Mailing Address - Street 2:
Mailing Address - City:GAYLORD
Mailing Address - State:MI
Mailing Address - Zip Code:49735-2043
Mailing Address - Country:US
Mailing Address - Phone:989-350-1385
Mailing Address - Fax:
Practice Address - Street 1:120 GRANDVIEW BLVD APT B115
Practice Address - Street 2:
Practice Address - City:GAYLORD
Practice Address - State:MI
Practice Address - Zip Code:49735-2043
Practice Address - Country:US
Practice Address - Phone:989-350-1385
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-19
Last Update Date:2024-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker