MEDICARE: MIA LOVE CPNP

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	363LP0200X	Pediatric Nurse Practitioner	4704264783	MI

General Provider Information

NPI Number	:	1295079895
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MIA LOVE CPNP

Provider Business Mailing Address
First Line	:	1 FORD PL STE 3A
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48202-3450
Country	:	US
Telephone Number	:	800-999-5829
Fax Number	:	313-876-1305

Provider Business Practice Location Address
First Line	:	10800 E CANFIELD ST
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48214-1601
Country	:	US
Telephone Number	:	313-823-6000
Fax Number	:	313-876-1305

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

Provider Enumeration Date	:	11/20/2012
Last Update Date	:	12/29/2025

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Directions to “ MIA LOVE CPNP” Practice Location

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