Provider Demographics
NPI:1952841975
Name:HANOVER, KAILA
Entity Type:Individual
Prefix:
First Name:KAILA
Middle Name:
Last Name:HANOVER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:187 SAINT PAUL ST STE 3B-1
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05401-4689
Mailing Address - Country:US
Mailing Address - Phone:802-745-7347
Mailing Address - Fax:
Practice Address - Street 1:187 SAINT PAUL ST STE 3B-1
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05401-4689
Practice Address - Country:US
Practice Address - Phone:802-745-7347
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-24
Last Update Date:2017-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory