Provider Demographics
NPI:1801040753
Name:HOOVER, CINNIAMON LANE (LPN)
Entity Type:Individual
Prefix:MRS
First Name:CINNIAMON
Middle Name:LANE
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 1:344 E CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:LISBON
Mailing Address - State:OH
Mailing Address - Zip Code:44432-1316
Mailing Address - Country:US
Mailing Address - Phone:330-424-7720
Mailing Address - Fax:
Practice Address - Street 1:344 E CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:LISBON
Practice Address - State:OH
Practice Address - Zip Code:44432-1316
Practice Address - Country:US
Practice Address - Phone:330-424-7720
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-05
Last Update Date:2008-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN 101391164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse