=====================================================
General NPI Number Information
=====================================================
NPI Number | 1457349557
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JANE E HOOVER RN MSN FNP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/12/2005
-----------------------------------------------------
Last Update Date | 02/15/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1207 MICHIGAN STREET SUITE C
-----------------------------------------------------
City | SANDPOINT
-----------------------------------------------------
State | ID
-----------------------------------------------------
Zip | 83864
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 208-265-2221
-----------------------------------------------------
Fax | 208-265-2229
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1207 MICHIGAN ST SUITE C
-----------------------------------------------------
City | SANDPOINT
-----------------------------------------------------
State | ID
-----------------------------------------------------
Zip | 83864-6608
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 208-265-2221
-----------------------------------------------------
Fax | 208-265-2229
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | RN00145168/AP3000619
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------