1336611797 NPI number — MERRILL ELIZABETH HOOVER MSN,FNP-BC

Table of content: MERRILL ELIZABETH HOOVER MSN,FNP-BC (NPI 1336611797)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336611797 NPI number — MERRILL ELIZABETH HOOVER MSN,FNP-BC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HOOVER
Provider First Name:
MERRILL
Provider Middle Name:
ELIZABETH
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MSN,FNP-BC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1336611797
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/26/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
23153 N RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FOWLER
Provider Business Mailing Address State Name:
KS
Provider Business Mailing Address Postal Code:
67844-9204
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
816-804-7230
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
510 E CARTHAGE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MEADE
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
67864-6401
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
620-873-2112
Provider Business Practice Location Address Fax Number:
620-873-5669
Provider Enumeration Date:
12/26/2018

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  53-78515-052 , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)