Healthcare Provider Details

I. General information

NPI: 1013274810
Provider Name (Legal Business Name): PATRICIA MARY HOVAGIM RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/18/2012
Last Update Date: 04/18/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 LODGE LN
MILLER PLACE NY
11764-1912
US

IV. Provider business mailing address

2 LODGE LN
MILLER PLACE NY
11764-1912
US

V. Phone/Fax

Practice location:
  • Phone: 631-331-2157
  • Fax:
Mailing address:
  • Phone: 631-331-2157
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number296297
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: