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General NPI Number Information
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NPI Number | 1144816406
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Entity Type | Individual
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Provider Name | MALLORY HOOVER
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Gender | Female
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Dates
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Enumeration Date | 12/21/2020
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Last Update Date | 05/27/2021
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Provider Practice Location Address
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Address Line | 801 N GRAND AVE
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City | MOUNT PLEASANT
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State | IA
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Zip | 52641-3120
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Country | US
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Telephone | 319-984-4775
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Fax |
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Provider Business Mailing Address
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Address Line | 3204 W MADISON AVE
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City | FAIRFIELD
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State | IA
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Zip | 52556-4733
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | F12200531
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License Number State | IA
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