Healthcare Provider Details

I. General information

NPI: 1609538057
Provider Name (Legal Business Name): CHACE LOVE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/12/2021
Last Update Date: 07/20/2023
Certification Date: 07/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

720 S RIVER RD STE D1100
SAINT GEORGE UT
84790-5522
US

IV. Provider business mailing address

3702 S STATE ST STE 107
SOUTH SALT LAKE UT
84115-5096
US

V. Phone/Fax

Practice location:
  • Phone: 435-251-5980
  • Fax: 435-251-5981
Mailing address:
  • Phone: 801-288-2634
  • Fax: 801-288-1186

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number10846140-3102
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number10846140-4405
License Number StateUT
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number10846140-8900
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: