Healthcare Provider Details

I. General information

NPI: 1073510079
Provider Name (Legal Business Name): GRETCHEN LEE HOOVER RN MSN FNPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2005
Last Update Date: 02/08/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4121 N KING RD KINGSTON CARE CENTER
SYLVANIA OH
43528
US

IV. Provider business mailing address

10834 LAKEVIEW DR
WHITEHOUSE OH
43571
US

V. Phone/Fax

Practice location:
  • Phone: 419-517-8200
  • Fax: 419-517-8208
Mailing address:
  • Phone: 419-351-6836
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN161261
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberNP04678
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: