Healthcare Provider Details

I. General information

NPI: 1487936787
Provider Name (Legal Business Name): BROOKE LYNNE HOVER RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/13/2011
Last Update Date: 09/13/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

58 QUAKER ST
GRANVILLE NY
12832-1513
US

IV. Provider business mailing address

58 QUAKER ST
GRANVILLE NY
12832-1513
US

V. Phone/Fax

Practice location:
  • Phone: 518-642-1051
  • Fax: 518-642-4544
Mailing address:
  • Phone: 518-642-1051
  • Fax: 518-642-4544

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number559162
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: