Healthcare Provider Details

I. General information

NPI: 1194996413
Provider Name (Legal Business Name): JENNIFER LEIGH HOVERSLAND APRN-FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/14/2008
Last Update Date: 03/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 KNAPP ST
WOLF POINT MT
59201-1826
US

IV. Provider business mailing address

7744 ROAD 2032
WOLF POINT MT
59201-7243
US

V. Phone/Fax

Practice location:
  • Phone: 406-653-2150
  • Fax:
Mailing address:
  • Phone: 406-392-5310
  • Fax: 406-392-5310

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number22945
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: