Individual
GWENDILYN SUZANNE LOVE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
4500 19TH ST LOT 398, BOULDER, CO 80304-0664
(720) 329-3494
Mailing address
4500 19TH ST LOT 398, BOULDER, CO 80304-0664
(720) 329-3494
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
PN.0046746
CO
Other
Enumeration date
01/10/2021
Last updated
01/10/2021
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