Healthcare Provider Details

I. General information

NPI: 1649744368
Provider Name (Legal Business Name): SHAUNA HOVEY LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/15/2019
Last Update Date: 01/15/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4016 MORNINGSIDE AVE STE C
SIOUX CITY IA
51106-2459
US

IV. Provider business mailing address

33591 479TH AVE
JEFFERSON SD
57038-6870
US

V. Phone/Fax

Practice location:
  • Phone: 712-258-9045
  • Fax:
Mailing address:
  • Phone: 712-389-4879
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number074771
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: