Healthcare Provider Details

I. General information

NPI: 1063128445
Provider Name (Legal Business Name): PERSONNA HOVER NA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: NA NA NA NA

II. Dates (important events)

Enumeration Date: 01/27/2023
Last Update Date: 01/27/2023
Certification Date: 01/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17320 W 12 MILE RD
SOUTHFIELD MI
48076-2100
US

IV. Provider business mailing address

17320 W 12 MILE RD
SOUTHFIELD MI
48076-2100
US

V. Phone/Fax

Practice location:
  • Phone: 313-974-1335
  • Fax:
Mailing address:
  • Phone: 313-974-1335
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: