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General NPI Number Information
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NPI Number | 1629402920
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Entity Type | Organization
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Legal Business Name | BRIDGETTE LOVE
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Dates
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Enumeration Date | 08/22/2013
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Last Update Date | 08/22/2013
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Provider Practice Location Address
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Address Line | 4045 S LAKE PARK AVE # 302
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City | CHICAGO
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State | IL
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Zip | 60653-2578
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Country | US
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Telephone | 773-924-5377
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Fax |
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Provider Business Mailing Address
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Address Line | 4045 S LAKE PARK AVE # 302
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City | CHICAGO
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State | IL
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Zip | 60653-2578
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Country | US
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Telephone | 773-924-5377
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Fax |
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Authorized Official
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Title or Position | REGISTERED NURSE/ICU
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Name | BRIDGETTE LOVE
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Credential | RN
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Telephone | 773-924-5377
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2865M2000X
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Taxonomy Name | Military General Acute Care Hospital
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License Number | 041319239
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License Number State | IL
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