Provider Demographics
NPI:1629108105
Name:HOVERSTEN, MARY ELIZABETH (CRNA, ARNP)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:ELIZABETH
Last Name:HOVERSTEN
Suffix:
Gender:F
Credentials:CRNA, ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:10120 S EASTERN AVE
Mailing Address - Street 2:230
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89052
Mailing Address - Country:US
Mailing Address - Phone:702-487-6880
Mailing Address - Fax:702-473-5455
Practice Address - Street 1:1020 S EASTERN AVE
Practice Address - Street 2:230
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052
Practice Address - Country:US
Practice Address - Phone:702-487-6880
Practice Address - Fax:702-473-5455
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-06
Last Update Date:2014-10-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NE101110367500000X
NV800195367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered