Healthcare Provider Details

I. General information

NPI: 1104522366
Provider Name (Legal Business Name): MORGAN ELIZABETH STOVER PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/31/2023
Last Update Date: 10/30/2024
Certification Date: 10/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3210 EAGLE RUN DR NE
GRAND RAPIDS MI
49525-7051
US

IV. Provider business mailing address

3922 MAYFIELD AVE NE APT 1H
GRAND RAPIDS MI
49525-2355
US

V. Phone/Fax

Practice location:
  • Phone: 616-456-9553
  • Fax: 616-454-5371
Mailing address:
  • Phone: 810-683-4185
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: