Provider Demographics
NPI:1336566264
Name:LOVE, AVIS COLLEEN (LPN)
Entity type:Individual
Prefix:MS
First Name:AVIS
Middle Name:COLLEEN
Last Name:LOVE
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:MISS
Other - First Name:AVIS
Other - Middle Name:COLLEEN
Other - Last Name:LINDSEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:41621 WEST ELEVEN MILE RD.
Mailing Address - Street 2:CENTRIA HEALTH CARE
Mailing Address - City:NOVI
Mailing Address - State:MI
Mailing Address - Zip Code:48375
Mailing Address - Country:US
Mailing Address - Phone:248-299-0030
Mailing Address - Fax:248-438-1566
Practice Address - Street 1:41621 WEST ELEVEN MILE RD.
Practice Address - Street 2:CENTRIA HEALTH CARE
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48375
Practice Address - Country:US
Practice Address - Phone:248-299-0030
Practice Address - Fax:248-438-1566
Is Sole Proprietor?:No
Enumeration Date:2014-03-28
Last Update Date:2014-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4703053762164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse