Healthcare Provider Details

I. General information

NPI: 1619334943
Provider Name (Legal Business Name): MARY MUKAMBA HOVE CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/17/2016
Last Update Date: 03/27/2026
Certification Date: 03/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 HIGH ST
BUFFALO NY
14203-1154
US

IV. Provider business mailing address

827 WILLOW RIDGE RD
TROY VA
22974-6224
US

V. Phone/Fax

Practice location:
  • Phone: 716-859-5600
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number960771
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: