Healthcare Provider Details

I. General information

NPI: 1932735925
Provider Name (Legal Business Name): NICHOLAS ROBERT LOVE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2020
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

123 WESTERN HILLS BLVD
CHEYENNE WY
82009-3446
US

IV. Provider business mailing address

123 WESTERN HILLS BLVD
CHEYENNE WY
82009-3446
US

V. Phone/Fax

Practice location:
  • Phone: 307-635-0226
  • Fax:
Mailing address:
  • Phone: 307-635-0226
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ND0900X
TaxonomyDermatopathology Physician
License Number18287A
License Number StateWY
# 2
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberA181102
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: