Healthcare Provider Details

I. General information

NPI: 1568129344
Provider Name (Legal Business Name): SARAH ELIZABETH STOVER CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/29/2021
Last Update Date: 11/29/2021
Certification Date: 11/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 E 1ST ST STE 404
DULUTH MN
55805-2297
US

IV. Provider business mailing address

9599 W SKYLINE PKWY
DULUTH MN
55810-2038
US

V. Phone/Fax

Practice location:
  • Phone: 218-722-5513
  • Fax: 218-722-6515
Mailing address:
  • Phone: 480-646-6300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number8113
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number8113
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: