Healthcare Provider Details

I. General information

NPI: 1568893089
Provider Name (Legal Business Name): LONNIE HOVDE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/09/2013
Last Update Date: 12/09/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1825 MARIKA RD
FAIRBANKS AK
99709-5521
US

IV. Provider business mailing address

1825 MARIKA RD
FAIRBANKS AK
99709-5521
US

V. Phone/Fax

Practice location:
  • Phone: 907-474-0890
  • Fax: 907-451-8945
Mailing address:
  • Phone: 907-474-0890
  • Fax: 907-451-8945

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: