Healthcare Provider Details

I. General information

NPI: 1346618691
Provider Name (Legal Business Name): JAN HOOVER FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/03/2015
Last Update Date: 01/10/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1025 MICHIGAN AVE STE 125
LOGANSPORT IN
46947
US

IV. Provider business mailing address

1025 MICHIGAN AVE STE 125
LOGANSPORT IN
46947-1664
US

V. Phone/Fax

Practice location:
  • Phone: 574-753-2222
  • Fax: 574-753-0522
Mailing address:
  • Phone: 574-722-2222
  • Fax: 574-753-0522

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number71005787A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: