Healthcare Provider Details

I. General information

NPI: 1316488331
Provider Name (Legal Business Name): LAURIE STOVER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/09/2017
Last Update Date: 03/09/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16935 6450 RD
MONTROSE CO
81403-7868
US

IV. Provider business mailing address

16935 6450 RD
MONTROSE CO
81403-7868
US

V. Phone/Fax

Practice location:
  • Phone: 970-249-1590
  • Fax: 970-765-2654
Mailing address:
  • Phone: 970-249-1590
  • Fax: 970-765-2654

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: