Provider Demographics
NPI:1760860837
Name:HOVERSON, JACQUELINE MAY (RN)
Entity Type:Individual
Prefix:MS
First Name:JACQUELINE
Middle Name:MAY
Last Name:HOVERSON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:224 E DEAN AVE
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53716-2104
Mailing Address - Country:US
Mailing Address - Phone:608-354-5303
Mailing Address - Fax:
Practice Address - Street 1:224 E DEAN AVE
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53716-2104
Practice Address - Country:US
Practice Address - Phone:608-354-5303
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-11
Last Update Date:2015-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI164472163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse