Healthcare Provider Details

I. General information

NPI: 1548910250
Provider Name (Legal Business Name): NICOLE MARIE HOOVER DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: NICOLE LAFAVE

II. Dates (important events)

Enumeration Date: 03/25/2022
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5492 N RONALD REAGAN PKWY STE 2105
BROWNSBURG IN
46112-5657
US

IV. Provider business mailing address

1100 SOUTHFIELD DR STE 1370
PLAINFIELD IN
46168-4300
US

V. Phone/Fax

Practice location:
  • Phone: 317-852-3851
  • Fax:
Mailing address:
  • Phone: 317-837-5566
  • Fax: 317-837-5567

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number11022172A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number02008029A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: