MEDICARE: MS. SHANNA LYNN LOVE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133V00000X	Registered Dietitian	875912	NV

General Provider Information

NPI Number	:	1063759819
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SHANNA LYNN LOVE

Provider Business Mailing Address
First Line	:	8205 W WARM SPRINGS RD
Second Line	:	SUITE 110
City	:	LAS VEGAS
State	:	NV
Zip	:	89113-3645
Country	:	US
Telephone Number	:	702-724-8888
Fax Number	:

Provider Business Practice Location Address
First Line	:	8205 W WARM SPRINGS RD
Second Line	:	SUITE 110
City	:	LAS VEGAS
State	:	NV
Zip	:	89113-3645
Country	:	US
Telephone Number	:	702-724-8888
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/14/2013
Last Update Date	:	01/14/2013

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