Basic Information
| Provider Information | |||||||||
| NPI: | 1639543861 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HOOVER | ||||||||
| FirstName: | NICOLE | ||||||||
| MiddleName: | LYNN | ||||||||
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| Credential: | NP-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 100 HOSPITAL AVE | ||||||||
| Address2: | |||||||||
| City: | DU BOIS | ||||||||
| State: | PA | ||||||||
| PostalCode: | 158011440 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8143712200 | ||||||||
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| Practice Location | |||||||||
| Address1: | 145 HOSPITAL AVE STE 101 | ||||||||
| Address2: | |||||||||
| City: | DU BOIS | ||||||||
| State: | PA | ||||||||
| PostalCode: | 158011463 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8143754089 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/27/2015 | ||||||||
| LastUpdateDate: | 04/12/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | SP015732 | PA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.