Provider Demographics
NPI:1093822793
Name:HOVINEN, SUSAN P (CNM)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:P
Last Name:HOVINEN
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:M
Other - Last Name:PARKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNM
Mailing Address - Street 1:PO BOX 845347
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-5347
Mailing Address - Country:US
Mailing Address - Phone:214-645-3838
Mailing Address - Fax:214-645-0078
Practice Address - Street 1:5323 HARRY HINES BLVD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75390-7201
Practice Address - Country:US
Practice Address - Phone:214-645-3838
Practice Address - Fax:214-645-0078
Is Sole Proprietor?:No
Enumeration Date:2006-08-25
Last Update Date:2016-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP104425367A00000X, 367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNR39911Medicare UPIN
MN411781624OtherBILLING TAX ID NUMBER
MN420001076Medicare PIN