Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LF0000X | Nurse Practitioner - Family Medicine | 53-77066 | KS |
Y | 363LP2300X | Nurse Practitioner - Primary Care | 53-77066 | KS |
NPI | 1093174054 |
---|---|
Provider Name | Chela Q Love |
First Address | Bel Aire, KS 67226-7674 |
Second Address | Bel Aire, KS 67226-7674 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/02/2016 |
Last Update Date | 08/03/2017 |