1629108105 NPI number — MARY ELIZABETH HOVERSTEN CRNA, ARNP

Table of content: MARY ELIZABETH HOVERSTEN CRNA, ARNP (NPI 1629108105)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629108105 NPI number — MARY ELIZABETH HOVERSTEN CRNA, ARNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HOVERSTEN
Provider First Name:
MARY
Provider Middle Name:
ELIZABETH
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CRNA, ARNP
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:
1629108105
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/28/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10120 S EASTERN AVE
Provider Second Line Business Mailing Address:
230
Provider Business Mailing Address City Name:
HENDERSON
Provider Business Mailing Address State Name:
NV
Provider Business Mailing Address Postal Code:
89052
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
702-487-6880
Provider Business Mailing Address Fax Number:
702-473-5455

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1020 S EASTERN AVE
Provider Second Line Business Practice Location Address:
230
Provider Business Practice Location Address City Name:
HENDERSON
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89052
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
702-487-6880
Provider Business Practice Location Address Fax Number:
702-473-5455
Provider Enumeration Date:
03/06/2007

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: 367500000X , with the licence number:  101110 , registered in the state of NE ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 367500000X , with the licence number: 800195 , registered in the state of NV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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