Provider Demographics
NPI:1861193898
Name:HOOVER, MALLORI (RN, IBCLC)
Entity type:Individual
Prefix:
First Name:MALLORI
Middle Name:
Last Name:HOOVER
Suffix:
Gender:F
Credentials:RN, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:278 DENVALE DR
Mailing Address - Street 2:
Mailing Address - City:SELMA
Mailing Address - State:NC
Mailing Address - Zip Code:27576-9206
Mailing Address - Country:US
Mailing Address - Phone:330-241-8551
Mailing Address - Fax:
Practice Address - Street 1:278 DENVALE DR
Practice Address - Street 2:
Practice Address - City:SELMA
Practice Address - State:NC
Practice Address - Zip Code:27576-9206
Practice Address - Country:US
Practice Address - Phone:330-241-8551
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-16
Last Update Date:2023-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCL-96870163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant