Healthcare Provider Details

I. General information

NPI: 1790165082
Provider Name (Legal Business Name): REBECCA LOVE NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: REBECCA SAMSON NP

II. Dates (important events)

Enumeration Date: 06/02/2015
Last Update Date: 04/08/2024
Certification Date: 04/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

915 4TH ST NW
CHOTEAU MT
59422-9123
US

IV. Provider business mailing address

915 4TH ST NW
CHOTEAU MT
59422-9123
US

V. Phone/Fax

Practice location:
  • Phone: 406-466-6085
  • Fax: 406-466-2159
Mailing address:
  • Phone: 406-466-6085
  • Fax: 406-466-6085

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number33762
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: