Provider Demographics
NPI:1104533413
Name:HOVER, JEREMY
Entity type:Individual
Prefix:
First Name:JEREMY
Middle Name:
Last Name:HOVER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3805 WASHINGTON AVE N
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55412-2141
Mailing Address - Country:US
Mailing Address - Phone:612-248-3000
Mailing Address - Fax:
Practice Address - Street 1:3805 WASHINGTON AVE N
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55412-2141
Practice Address - Country:US
Practice Address - Phone:612-248-3000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-07
Last Update Date:2023-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNHLDG22-0005177F00000X
MNLIC405011177F00000X
MNLIC404583177F00000X
MNHLDG22-0006177F00000X
MNHLDG22-0007177F00000X
MNHLDG22-0004177F00000X
MNLIC405205177F00000X
MNHLDG22-0003177F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes177F00000XOther Service ProvidersLodging