MEDICARE: LAURA LOVE PH.D, PA-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	363A00000X	Physician Assistant	6643	AZ

General Provider Information

NPI Number	:	1801334057
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAURA LOVE PH.D, PA-C

Provider Business Mailing Address
First Line	:	1593 W BROWNING WAY
Second Line	:
City	:	CHANDLER
State	:	AZ
Zip	:	85286-0908
Country	:	US
Telephone Number	:	480-262-1792
Fax Number	:

Provider Business Practice Location Address
First Line	:	3377 S PRICE RD
Second Line	:
City	:	CHANDLER
State	:	AZ
Zip	:	85248-3573
Country	:	US
Telephone Number	:	480-525-7874
Fax Number	:

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

Provider Enumeration Date	:	02/08/2017
Last Update Date	:	09/20/2024

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