Healthcare Provider Details

I. General information

NPI: 1588945737
Provider Name (Legal Business Name): CYNTHIA ANN LOVE CPNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/01/2011
Last Update Date: 09/01/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1045 W 146TH ST
CARMEL IN
46032-1118
US

IV. Provider business mailing address

1045 W 146TH ST
CARMEL IN
46032-1118
US

V. Phone/Fax

Practice location:
  • Phone: 317-819-0772
  • Fax:
Mailing address:
  • Phone: 317-819-0772
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number28081028A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: