Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208D00000X | General Practice Physician | 20050468 | NM |
NPI | 1033238597 |
---|---|
Provider Name | Dr. Joann Love |
First Address | Truth Or Consequences, NM 87901-3319 |
Second Address | T Or C, NM 87901-3319 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/03/2007 |
Last Update Date | 27/03/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01786342 | (05) | NM |
28777841 | (05) | NM |
46650024 | (05) | NM |
51305879 | (05) | NM |
53938577 | (05) | NM |
73805858 | (05) | NM |
NM301541 | (02) | NM |