Healthcare Provider Details

I. General information

NPI: 1639543861
Provider Name (Legal Business Name): NICOLE LYNN HOOVER NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/27/2015
Last Update Date: 04/12/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

145 HOSPITAL AVE STE 101
DU BOIS PA
15801-1463
US

IV. Provider business mailing address

100 HOSPITAL AVE
DU BOIS PA
15801-1440
US

V. Phone/Fax

Practice location:
  • Phone: 814-375-4089
  • Fax:
Mailing address:
  • Phone: 814-371-2200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberSP015732
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: