Healthcare Provider Details

I. General information

NPI: 1578997714
Provider Name (Legal Business Name): JENNIFER MAE HOVIS NNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/23/2013
Last Update Date: 08/23/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 CHILDRENS PL
SAINT LOUIS MO
63110-1002
US

IV. Provider business mailing address

2808 ARSENAL ST
SAINT LOUIS MO
63118-2302
US

V. Phone/Fax

Practice location:
  • Phone: 314-454-6037
  • Fax:
Mailing address:
  • Phone: 618-960-4566
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LN0000X
TaxonomyNeonatal Nurse Practitioner
License Number2013031606
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: