MEDICARE: JAMELA LOVE NP-C

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	363L00000X	Nurse Practitioner	2015037584	MO
2	363LG0600X	Gerontology Nurse Practitioner	2015037584	MO

General Provider Information

NPI Number	:	1689034860
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMELA LOVE NP-C

Provider Business Mailing Address
First Line	:	4100 UNION BLVD
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63115-1225
Country	:	US
Telephone Number	:	314-531-1112
Fax Number	:

Provider Business Practice Location Address
First Line	:	4100 UNION BLVD
Second Line	:	UNIT B
City	:	SAINT LOUIS
State	:	MO
Zip	:	63115-1225
Country	:	US
Telephone Number	:	314-531-1112
Fax Number	:

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

Provider Enumeration Date	:	03/01/2016
Last Update Date	:	06/19/2019

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Directions to “ JAMELA LOVE NP-C” Practice Location

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