Healthcare Provider Details

I. General information

NPI: 1841449899
Provider Name (Legal Business Name): DEANNA STOVER RN, C, FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/15/2008
Last Update Date: 09/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

802 W COLTON AVE STE E
REDLANDS CA
92374-2905
US

IV. Provider business mailing address

PO BOX 2074
RUNNING SPRINGS CA
92382-2074
US

V. Phone/Fax

Practice location:
  • Phone: 909-335-8323
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number10525
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code364SA2200X
TaxonomyAdult Health Clinical Nurse Specialist
License Number2154
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: