Healthcare Provider Details

I. General information

NPI: 1457669285
Provider Name (Legal Business Name): WENDY LEE STOVERN LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/14/2010
Last Update Date: 09/14/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6525 BERGSTROM RD
SAGINAW MN
55779-9572
US

IV. Provider business mailing address

6525 BERGSTROM RD
SAGINAW MN
55779-9572
US

V. Phone/Fax

Practice location:
  • Phone: 218-729-7986
  • Fax:
Mailing address:
  • Phone: 218-729-7986
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License NumberL32367-7
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: