Healthcare Provider Details

I. General information

NPI: 1629581384
Provider Name (Legal Business Name): ANTHONY DAVID LOVE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/15/2017
Last Update Date: 11/15/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 LOYOLA AVE STE 106
NEW ORLEANS LA
70113-1912
US

IV. Provider business mailing address

2424 ARTILLERY DR
CHALMETTE LA
70043-4304
US

V. Phone/Fax

Practice location:
  • Phone: 504-558-9595
  • Fax: 504-558-9599
Mailing address:
  • Phone: 540-664-8356
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License NumberRN136229
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: