Michael Shane Love, C-EP

Individual provider Active NPI Nutrition Education Nutritionist · Lavale, MD

NPI 1124664958 · NPPES record last updated Nov 27, 2019

Key facts

NPI
1124664958
Entity type
Individual (NPI type 1)
Primary specialty
Nutrition Education Nutritionist 133NN1002X
License
1024667
Practice address
957 National Hwy
Lavale, MD 21502-7356
Phone
(301) 729-9475
NPI assigned
Nov 27, 2019
Sex
Male
Sole proprietor
No

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
No

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Nutrition Education Nutritionist 133NN1002X 1024667 Yes

Addresses

Primary practice location

957 National Hwy
Lavale, MD 21502-7356

Mailing address

957 National Hwy
Lavale MD 21502
Lavale, MD 21502
Phone (307) 729-9475

Other providers in Lavale, MD

All providers in Lavale, MD · Nutrition Education Nutritionist in Maryland

Sources for this page

Verify at the official NPI Registry.