Healthcare Provider Details

I. General information

NPI: 1033238597
Provider Name (Legal Business Name): JOANN LOVE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/28/2007
Last Update Date: 03/27/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

565 DANIELS ST
T OR C NM
87901-3319
US

IV. Provider business mailing address

565 DANIELS ST
TRUTH OR CONSEQUENCES NM
87901-3319
US

V. Phone/Fax

Practice location:
  • Phone: 575-740-0427
  • Fax: 575-894-0777
Mailing address:
  • Phone: 575-740-0427
  • Fax: 575-894-0777

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License Number20050468
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number20050468
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: