Provider Demographics
NPI:1336798867
Name:HOOVER, JENNIFER (RN)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:HOOVER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:68 WILSON CREEK RD
Mailing Address - Street 2:
Mailing Address - City:NEWARK VALLEY
Mailing Address - State:NY
Mailing Address - Zip Code:13811-2601
Mailing Address - Country:US
Mailing Address - Phone:607-642-8351
Mailing Address - Fax:
Practice Address - Street 1:68 WILSON CREEK RD
Practice Address - Street 2:
Practice Address - City:NEWARK VALLEY
Practice Address - State:NY
Practice Address - Zip Code:13811-2601
Practice Address - Country:US
Practice Address - Phone:607-642-8351
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-06
Last Update Date:2019-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY735534163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool