Healthcare Provider Details

I. General information

NPI: 1790354017
Provider Name (Legal Business Name): WILLIAM HOVEKE LMT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2021
Last Update Date: 06/21/2021
Certification Date: 06/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2860 S BRONCO ST
LAS VEGAS NV
89146-5208
US

IV. Provider business mailing address

3554 SIERRA PATRICIA AVE
LAS VEGAS NV
89121-5811
US

V. Phone/Fax

Practice location:
  • Phone: 702-326-8177
  • Fax:
Mailing address:
  • Phone: 702-326-8177
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number10307
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: