Provider Demographics
NPI:1699932129
Name:LOVE, MIKEL DIONNE (MS RD)
Entity type:Individual
Prefix:MRS
First Name:MIKEL
Middle Name:DIONNE
Last Name:LOVE
Suffix:
Gender:F
Credentials:MS RD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 2207
Mailing Address - Street 2:
Mailing Address - City:DURANGO
Mailing Address - State:CO
Mailing Address - Zip Code:81302-2207
Mailing Address - Country:US
Mailing Address - Phone:970-259-1712
Mailing Address - Fax:970-259-2466
Practice Address - Street 1:2530 COLORADO AVE
Practice Address - Street 2:SUITE 2A
Practice Address - City:DURANGO
Practice Address - State:CO
Practice Address - Zip Code:81301-4760
Practice Address - Country:US
Practice Address - Phone:970-259-1712
Practice Address - Fax:970-259-2466
Is Sole Proprietor?:No
Enumeration Date:2008-05-21
Last Update Date:2013-07-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CO951051133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO805339Medicare PIN