Provider Demographics
NPI:1346618691
Name:HOOVER, JAN (FNP)
Entity Type:Individual
Prefix:
First Name:JAN
Middle Name:
Last Name:HOOVER
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1025 MICHIGAN AVE STE 125
Mailing Address - Street 2:
Mailing Address - City:LOGANSPORT
Mailing Address - State:IN
Mailing Address - Zip Code:46947-1664
Mailing Address - Country:US
Mailing Address - Phone:574-722-2222
Mailing Address - Fax:574-753-0522
Practice Address - Street 1:1025 MICHIGAN AVE STE 125
Practice Address - Street 2:
Practice Address - City:LOGANSPORT
Practice Address - State:IN
Practice Address - Zip Code:46947
Practice Address - Country:US
Practice Address - Phone:574-753-2222
Practice Address - Fax:574-753-0522
Is Sole Proprietor?:No
Enumeration Date:2015-09-03
Last Update Date:2019-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71005787A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily