Provider Demographics
NPI:1629843818
Name:HOOVER, LYDIA MICHELLE (APRN)
Entity Type:Individual
Prefix:DR
First Name:LYDIA
Middle Name:MICHELLE
Last Name:HOOVER
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1398 W DUPONT AVE
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84116-3606
Mailing Address - Country:US
Mailing Address - Phone:801-425-3626
Mailing Address - Fax:
Practice Address - Street 1:1398 W DUPONT AVE
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84116-3606
Practice Address - Country:US
Practice Address - Phone:801-425-3626
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-17
Last Update Date:2023-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT9412429-8900363LA2100X
UT9412429-4405363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care