Provider Demographics
NPI:1588780498
Name:HOVANEC, LAURA MARIE (NP)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:MARIE
Last Name:HOVANEC
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:MARIE
Other - Last Name:KOMINIAREK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:921 S EDWIN C MOSES BLVD
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45417-3464
Mailing Address - Country:US
Mailing Address - Phone:937-461-1376
Mailing Address - Fax:937-461-9280
Practice Address - Street 1:921 S EDWIN C MOSES BLVD
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45417-3464
Practice Address - Country:US
Practice Address - Phone:937-461-1376
Practice Address - Fax:937-461-9280
Is Sole Proprietor?:No
Enumeration Date:2007-03-22
Last Update Date:2016-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHNP05032363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH213276Medicaid
OHS81859Medicare UPIN