Provider Demographics
NPI:1255309738
Name:ROVA, NANCY L (MD)
Entity Type:Individual
Prefix:DR
First Name:NANCY
Middle Name:L
Last Name:ROVA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1502 LONDON ROAD
Mailing Address - Street 2:102
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55812
Mailing Address - Country:US
Mailing Address - Phone:218-576-0100
Mailing Address - Fax:
Practice Address - Street 1:1502 LONDON ROAD
Practice Address - Street 2:102
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55812
Practice Address - Country:US
Practice Address - Phone:218-576-0100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-09
Last Update Date:2011-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN35481207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN844318100Medicaid
MN9V846OLOtherBLUE CROSS
MN926741014029OtherPREFERRED
MN080081174Medicare ID - Type UnspecifiedRAILROAD MEDICARE
MN844318100Medicaid
MN926741014029OtherPREFERRED