Provider Demographics
NPI:1528202025
Name:VANOVER, PATRICIA DOUGLASS (CNS)
Entity Type:Individual
Prefix:MRS
First Name:PATRICIA
Middle Name:DOUGLASS
Last Name:VANOVER
Suffix:
Gender:F
Credentials:CNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3501 KNICKERBOCKER RD
Mailing Address - Street 2:
Mailing Address - City:SAN ANGELO
Mailing Address - State:TX
Mailing Address - Zip Code:76904-7610
Mailing Address - Country:US
Mailing Address - Phone:325-947-6605
Mailing Address - Fax:325-947-6607
Practice Address - Street 1:3334 LOOP 306
Practice Address - Street 2:
Practice Address - City:SAN ANGELO
Practice Address - State:TX
Practice Address - Zip Code:76904-5941
Practice Address - Country:US
Practice Address - Phone:325-947-6605
Practice Address - Fax:325-947-6607
Is Sole Proprietor?:No
Enumeration Date:2009-04-28
Last Update Date:2009-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX456340364S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse Specialist