Provider Demographics
NPI:1841541372
Name:HOOVER, CRYSTAL LYNN
Entity type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:LYNN
Last Name:HOOVER
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 1:8621 SAINT PETERS CHURCH RD
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44641-9733
Mailing Address - Country:US
Mailing Address - Phone:330-935-2573
Mailing Address - Fax:
Practice Address - Street 1:8621 SAINT PETERS CHURCH RD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:OH
Practice Address - Zip Code:44641-9733
Practice Address - Country:US
Practice Address - Phone:330-935-2573
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-24
Last Update Date:2012-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH400524680806374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide