Provider Demographics
NPI:1255106175
Name:HOVEN, LISA LYNNE (CNA)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:LYNNE
Last Name:HOVEN
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 ROCKY POINT RD
Mailing Address - Street 2:
Mailing Address - City:KELSO
Mailing Address - State:WA
Mailing Address - Zip Code:98626-4021
Mailing Address - Country:US
Mailing Address - Phone:360-751-2352
Mailing Address - Fax:
Practice Address - Street 1:1700 HUDSON ST STE 105
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:WA
Practice Address - Zip Code:98632-2931
Practice Address - Country:US
Practice Address - Phone:360-504-0122
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-21
Last Update Date:2023-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA10057616374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide