Healthcare Provider Details

I. General information

NPI: 1629402920
Provider Name (Legal Business Name): BRIDGETTE LOVE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/22/2013
Last Update Date: 08/22/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4045 S LAKE PARK AVE # 302
CHICAGO IL
60653-2578
US

IV. Provider business mailing address

4045 S LAKE PARK AVE # 302
CHICAGO IL
60653-2578
US

V. Phone/Fax

Practice location:
  • Phone: 773-924-5377
  • Fax:
Mailing address:
  • Phone: 773-924-5377
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2865M2000X
TaxonomyMilitary General Acute Care Hospital
License Number041319239
License Number StateIL

VIII. Authorized Official

Name: BRIDGETTE LOVE
Title or Position: REGISTERED NURSE/ICU
Credential: RN
Phone: 773-924-5377