Healthcare Provider Details

I. General information

NPI: 1023612892
Provider Name (Legal Business Name): SABRA LEANNE LOVE RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/23/2020
Last Update Date: 11/23/2020
Certification Date: 11/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25201 E 78 HWY
INDEPENDENCE MO
64056
US

IV. Provider business mailing address

5129 S POWELL AVE
BLUE SPRINGS MO
64015-2244
US

V. Phone/Fax

Practice location:
  • Phone: 816-796-7307
  • Fax: 816-796-7305
Mailing address:
  • Phone: 312-513-8553
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WX0106X
TaxonomyOccupational Health Registered Nurse
License Number103207
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: