Healthcare Provider Details

I. General information

NPI: 1346104312
Provider Name (Legal Business Name): MARSHAE QUIENNIECE LOVE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/12/2025
Last Update Date: 12/12/2025
Certification Date: 12/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2313 W 28TH AVE
PINE BLUFF AR
71603-5049
US

IV. Provider business mailing address

2313 W 28TH AVE
PINE BLUFF AR
71603-5049
US

V. Phone/Fax

Practice location:
  • Phone: 262-393-1661
  • Fax:
Mailing address:
  • Phone: 262-393-1661
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374700000X
TaxonomyTechnician
License Number
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: