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General NPI Number Information
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NPI Number | 1649814336
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Entity Type | Individual
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Provider Name | KEIASIA LOVE
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Gender | Female
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Dates
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Enumeration Date | 11/05/2019
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Last Update Date | 11/05/2019
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Provider Practice Location Address
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Address Line | 2151 RUSH BLVD
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City | YOUNGSTOWN
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State | OH
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Zip | 44507-1535
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Country | US
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Telephone | 330-744-1181
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Fax | 330-740-2489
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Provider Business Mailing Address
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Address Line | 5171 SAMPSON DR
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City | YOUNGSTOWN
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State | OH
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Zip | 44505-1253
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Country | US
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Telephone | 330-398-0555
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | RN.424412
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License Number State | OH
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