Healthcare Provider Details

I. General information

NPI: 1942428073
Provider Name (Legal Business Name): KATHLEEN SOBUS STOVER RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/23/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

931 BLUE RIDGE DR
ANNAPOLIS MD
21409-5203
US

IV. Provider business mailing address

521 LITTLE CURRENT DR
ANNAPOLIS MD
21409-5643
US

V. Phone/Fax

Practice location:
  • Phone: 410-222-1689
  • Fax: 410-222-1687
Mailing address:
  • Phone: 410-757-4282
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License NumberRO66678
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: