MEDICARE: ANNA M LOVE RN

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	163W00000X	Registered Nurse	7078138	NY

General Provider Information

NPI Number	:	1164790739
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANNA M LOVE RN

Provider Business Mailing Address
First Line	:	3780 S PARK AVE
Second Line	:
City	:	BLASDELL
State	:	NY
Zip	:	14219-1805
Country	:	US
Telephone Number	:	716-926-1700
Fax Number	:

Provider Business Practice Location Address
First Line	:	3780 S PARK AVE
Second Line	:
City	:	BUFFALO
State	:	NY
Zip	:	14219-1805
Country	:	US
Telephone Number	:	716-926-1750
Fax Number	:

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

Provider Enumeration Date	:	12/09/2011
Last Update Date	:	12/09/2011

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