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NPI Code Detail

MEDICARE: SUSAN LOVE CRNA

MEDICARE: SUSAN LOVE CRNA
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
1367500000XCertified Registered Nurse Anesthetist092708MO

General Provider Information

NPI Number : 1255345906
Entity Type Code : Individual
Provider Name (Legal Business Name) : SUSAN LOVE CRNA
Provider Business Mailing Address
First Line : 4925 S PRATT AVE
Second Line :
City : SPRINGFIELD
State : MO
Zip : 65804-7527
Country : US
Telephone Number : 417-848-2044
Fax Number :
Provider Business Practice Location Address
First Line : 100 HOSPITAL DR
Second Line :
City : LEBANON
State : MO
Zip : 65536-9210
Country : US
Telephone Number : 417-533-6100
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/28/2006
Last Update Date : 07/08/2007

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Directions to “ SUSAN LOVE CRNA” Practice Location

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