Provider Demographics
NPI:1558774604
Name:BOVA, DAWN R (CNP)
Entity Type:Individual
Prefix:
First Name:DAWN
Middle Name:R
Last Name:BOVA
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:402 MCPHERSON HWY
Mailing Address - Street 2:
Mailing Address - City:CLYDE
Mailing Address - State:OH
Mailing Address - Zip Code:43410-1133
Mailing Address - Country:US
Mailing Address - Phone:419-483-4040
Mailing Address - Fax:419-547-2815
Practice Address - Street 1:402 MCPHERSON HWY
Practice Address - Street 2:
Practice Address - City:CLYDE
Practice Address - State:OH
Practice Address - Zip Code:43410-1133
Practice Address - Country:US
Practice Address - Phone:419-483-4040
Practice Address - Fax:419-547-2815
Is Sole Proprietor?:No
Enumeration Date:2014-06-06
Last Update Date:2014-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOA15876363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner