Provider Demographics
NPI:1558580258
Name:HOOVER, DORA GWEN (LPN)
Entity Type:Individual
Prefix:MRS
First Name:DORA
Middle Name:GWEN
Last Name:HOOVER
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8390 OAK DR
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:MD
Mailing Address - Zip Code:21122-4604
Mailing Address - Country:US
Mailing Address - Phone:410-424-3214
Mailing Address - Fax:
Practice Address - Street 1:715 COOPER RD
Practice Address - Street 2:
Practice Address - City:GLEN BURNIE
Practice Address - State:MD
Practice Address - Zip Code:21060-7785
Practice Address - Country:US
Practice Address - Phone:410-424-3214
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLP30600390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program