Healthcare Provider Details

I. General information

NPI: 1518134345
Provider Name (Legal Business Name): LORETTA LOVE M.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/12/2008
Last Update Date: 05/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8726 W MILL RD
MILWAUKEE WI
53225-1838
US

IV. Provider business mailing address

5240 N 51ST BLVD
MILWAUKEE WI
53218-3301
US

V. Phone/Fax

Practice location:
  • Phone: 414-353-9250
  • Fax:
Mailing address:
  • Phone: 414-758-5950
  • Fax: 414-462-8994

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number39627100
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: