MEDICARE: CHERI VAN HOOVER CNM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	367A00000X	Advanced Practice Midwife	AP300006557	WA

General Provider Information

NPI Number	:	1548472301
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHERI VAN HOOVER CNM

Provider Business Mailing Address
First Line	:	PO BOX 1658
Second Line	:
City	:	PORT HADLOCK
State	:	WA
Zip	:	98339-1658
Country	:	US
Telephone Number	:	360-385-1104
Fax Number	:

Provider Business Practice Location Address
First Line	:	1106 E 1ST ST
Second Line	:
City	:	PORT ANGELES
State	:	WA
Zip	:	98362-4317
Country	:	US
Telephone Number	:	360-452-2954
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/04/2007
Last Update Date	:	07/08/2007

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