Provider Demographics
NPI:1073510079
Name:HOOVER, GRETCHEN LEE (RN MSN FNPC)
Entity Type:Individual
Prefix:MRS
First Name:GRETCHEN
Middle Name:LEE
Last Name:HOOVER
Suffix:
Gender:F
Credentials:RN MSN FNPC
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Mailing Address - Street 1:10834 LAKEVIEW DR
Mailing Address - Street 2:
Mailing Address - City:WHITEHOUSE
Mailing Address - State:OH
Mailing Address - Zip Code:43571
Mailing Address - Country:US
Mailing Address - Phone:419-351-6836
Mailing Address - Fax:
Practice Address - Street 1:4121 N KING RD
Practice Address - Street 2:KINGSTON CARE CENTER
Practice Address - City:SYLVANIA
Practice Address - State:OH
Practice Address - Zip Code:43528
Practice Address - Country:US
Practice Address - Phone:419-517-8200
Practice Address - Fax:419-517-8208
Is Sole Proprietor?:No
Enumeration Date:2005-07-05
Last Update Date:2012-02-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OHRN161261363LF0000X
OHNP04678363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
P22690Medicare UPIN