Healthcare Provider Details

I. General information

NPI: 1992638092
Provider Name (Legal Business Name): LOVE AND LIGHT FAMILY PRACTICE, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/08/2026
Last Update Date: 07/26/2026
Certification Date: 07/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5106 BARTHOLOMEWS LN
GREENSBORO NC
27407-2726
US

IV. Provider business mailing address

701 GREEN VALLEY RD STE 100
GREENSBORO NC
27408-7096
US

V. Phone/Fax

Practice location:
  • Phone: 336-609-9105
  • Fax: 336-313-2526
Mailing address:
  • Phone: 336-609-9105
  • Fax: 336-313-2526

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MS. LE'STARR M ROSE
Title or Position: OWNER. FOUNDER
Credential: FNP
Phone: 248-396-3295