Healthcare Provider Details

I. General information

NPI: 1619231354
Provider Name (Legal Business Name): NICOLE A HOVER RPA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2012
Last Update Date: 08/02/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1220 NEW SCOTLAND RD SUITE 103
SLINGERLANDS NY
12159-9386
US

IV. Provider business mailing address

AMC COMMUNITY GI 1769 UNION STREET
SCHENECTADY NY
12309
US

V. Phone/Fax

Practice location:
  • Phone: 518-439-4326
  • Fax: 518-439-6143
Mailing address:
  • Phone: 518-264-4895
  • Fax: 518-881-0003

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number015671
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: